Order Intake Representative - Level 1 (53267)

 

Performance Home Medical has been a leader in providing quality products and services since 1995.

At Performance Home Medical, our patients come first. Using the latest technology and best clinical support, we help our patients take control of their conditions and live longer and healthier.

Position Summary: The Order Intake Representative ensures accurate proof of delivery documentation and compliance with insurance and regulatory requirements to support timely reimbursement and revenue flow. This role involves reviewing and confirming patient delivery tickets, auditing accounts for accuracy, and assisting with escalated billing reviews while maintaining a strong understanding of payer guidelines, ABN/waiver requirements, and HIPAA regulations. Representatives work designated tasks and reports to uphold state, federal, and company standards, meet key performance metrics, and contribute to continuous improvement initiatives. 

Job Duties and Responsibilities include the following. Other duties may be assigned.

• Understand insurance requirements for all modalities of Positive Airway Pressure devices (PAP.)
• Review incoming documentation accurately and in a timely manner to insure timely set up of 
  patient equipment.
• Enter patients / information into the PHM electronic medical record program with accuracy.
• Corresponds with referral sources and sales team for the receipt of missing documentation to 
  assist in favorable financial outcomes.
• Understand insurance coverage criteria to dispense correct information to the patient.
• Answer incoming calls in an efficient and courteous manner including patients and all PHM staff.
• Maintaining current knowledge of changes to insurance policies and workflows.
• Collaborate with other PHM employees to provide exceptional support to PHM customers.
• Meet key performance metrics with consistent productivity and accuracy 
• Other tasks that may be assigned by the direct supervisor or manager.
• Complies with all applicable company policies and procedures.
• Ensures that all inquiries, orders, and requests are handled in an accurate and timely manner. 
• Screens and directs telephone calls and receives orders from referral sources.
• Coordinates all intake patient information and processes paperwork, including uploading into 
  patient’s file.
• Establishes client records and ensures all patient information and records are current and 
  complete and coordinates information with correct PHM department.
• Verifies insurance eligibility of patients.
• Takes complaints or concerns regarding service rendered, referring complaints of service failures 
  to designated department supervisors for investigation.
• Develops and maintains working knowledge of current products and services offered by PHM 
  and all applicable insurance guidelines regarding eligibility for coverage and reimbursement.
• Monitors and records client, physician, and referral source communications. Notifies appropriate 
  personnel if a service or response, within the scope of their responsibilities, is required.
• Assists with the implementation of performance improvement programs to meet company, state, 
  federal, and accreditation standards.
• Always maintain patient confidentiality according to company policy.
• Perform other tasks that may be assigned by the direct supervisor or manager.

This role is part of the Order Qualification Representative job family, which includes levels 1-4. 
Advancement is based on demonstrated competencies and business needs.

• Level 1 - New orders for all payors
• Level 2 - Bi-PAP/CIM for all payors
• Level 3 - Replacements/Supply orders for all payors
• Level 4 - Advanced BI-PAP orders, Admin responsibilities, and Pending (follow-up documentation from referral sources and patients)

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Education/Experience: Associate degree (A.A.) or equivalent from two-year college or technical school; or six months to one-year related experience and/or training; or equivalent combination of education and experience.

• Knowledge of home medical equipment
• Basic knowledge of medical terminology/ICD codes preferred.
• Type at least 40 words per minute with no errors
• Organizational skills

Language Ability: Read and interpret complex documents. Respond effectively to sensitive inquiries. 

Mathematical Ability: Addition, Subtraction, Multiplication, and Division. Work with whole numbers, decimals, and fractions. Knows times tables and how to calculate change, prices, or totals.

Reasoning Ability: Apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Deal with problems involving a few concrete variables in standardized situations.
Computer Skills: Fluency in Microsoft Office (Word, Outlook, Chrome, Internet Explorer, SharePoint).

Certificates and Licenses: N/A

Travel Requirements: Traveling as needed within region/territory. Have reliable means of transportation. Meet requirements of our Motor Vehicle policy.

Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually unpredictable.

Physical Demands:

While performing the duties of this Job, the employee is regularly required to sit; use hands to type finger, handle, or feel. The employee is frequently required to stand and walk. The employee is occasionally required to reach with hands and arms; climb or balance and stoop, kneel, crouch, or crawl. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 20 pounds.

The above job description is not intended to be an all-inclusive list of duties and standards of the position and can be modified as needed. Incumbents will follow any other instructions, and perform any other related duties, as assigned by their supervisor.

All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an “at will” relationship.