Customer Order Specialist Supervisor - Durable Medical Equipment

The Kestra team has over 400 years of experience in the external and internal cardiac medical device markets. The company was founded in 2014 by industry leaders inspired by the opportunity to unite modern wearable technologies with proven device therapies. Kestra’s solutions combine high quality and technical performance with a wearable design that provides the greatest regard for patient comfort and dignity. Innovating versatile new ways to deliver care, Kestra is helping patients, and their care teams harmoniously monitor, manage, and protect life.

The Durable Medical Equipment (DME) Customer Order Specialist Supervisor is responsible for supervising the day-to-day operations for the Order Processing Team by supporting the order processing needs of customers, patients, and field sales personnel via fax, phone, email, and chatter. A primary focus in supervising the Customer Order Specialists (COSs), is ensuring customer service is at the forefront of everything they do, whilst ensuring strict standards and the timeframes as promised to the customer are achieved. You will be the escalated point of contact for any issues, so you must be happy with being a keen problem solver and trainer. As a team supervisor, you will be responsible for driving a culture of inclusion and engagement through regular team meetings and 1:1s and team building activities.

This role regularly communicates with field sales personnel, patients, health care providers, health Insurance (payor) representatives and referral sources as it relates to competently and efficiently requesting and obtaining payor prior authorizations on behalf of patients in a friendly, caring, and professional manner. Frequently, this position discusses insurance benefits, out-of-pocket costs, deductibles, and payment methods with patients. This role helps train Customer Order Specialists in these duties.

ESSENTIAL DUTIES:

• Supervise regional COS team(s) as assigned by Manager, including scheduling work shifts to effectively cover the needs of Kestra customers
• Participate in hiring, training, and coaching
• Conduct performance evaluations of COSs
• Perform COS duties as needed
• Ensure accurate intake and processing of orders
• Serve as escalation contact for regional order-related issues
• Facilitate the entirety of the order process to ensure efficiency and effectiveness
• Help troubleshoot order processing concerns
• Make sure the teams KPI’s are achieved
• Listen to COS calls to patients and payers
• Attend and participate in Order Processing Leadership meetings as needed

• Coordinate with sales representatives, physician’s office, and applicable internal/external personnel regarding medical records and information needed to obtain pre-authorization and benefits upon intake of new patient referrals. Confirm medical records meet medical necessity based on applicable insurance guidelines. Promptly follow-up on patient referrals, physician prescriptions and/or physician work orders

• Verify eligibility and benefits of patient health insurance specific to Durable Medical Equipment (DME) by contacting insurance companies by phone, accessing insurance website portals, and utilizing Kestra’s medical billing software. Responsible for verification of active coverage, deductibles, accumulations, coinsurance, and pre-authorization requirements
• Initiate, track, and complete pre-authorizations requests, including notifying applicable parties of the determination. Assist with appeals for Prior Authorization denials
• Upon authorization, place orders for Durable Medical Equipment, notify, and dispatch patient product fitters
• Perform data entry into medical billing software and other software (Salesforce) including patient demographics, prescribing physician’s information, insurance payor information, HCPCS procedure codes, ICD-10 diagnosis codes, etc.
• Collaborate with the Billing Team as necessary and as directed by the Order Processing Manager to help facilitate the submission of claims to payers
• Regularly communicate with patients to discuss their insurance benefits, out-of-pocket costs, and product payment arrangements
• Escalate issues within insurance carriers when not able to obtain reasonable information
• Answer incoming phone calls to office and route messages accordingly
• Routinely export/import data from one software to another software
• Create forms through auto-populating data into custom fields
• Accurately complete forms/applications and send out to applicable destination
• Be aware of and adapt to changes in medical regulations and processes
• Participate in on-call and off hours coverage. Hours on-call and worked may include evenings, weekends, and holidays.
• Adhere to Pledge of Confidentiality