Lead Specialist, Member Transition

Description

We're looking for a Lead Specialist, Member Transition, working in Healthcare Systems and Services industry in Fully Remote, Chicago, Illinois, United States.

If you're an innovator who is eager to break down barriers and be a catalyst for change in the healthcare industry, you might have just found your next professional home!

Synapse Health | Who We Are

With the collective efforts of our epic team members, we're trailblazing a new path in theDMEindustry. Synapse Health was founded in 2016 with a goal to fix the fracturedDMEecosystem and completely transform the industry. Built on decades of industry and leadership experience, we've launched tech-based solutions that eliminate age-oldDMEheadaches, resulting in a seamless experience for all. We are proud to offer work that matters, on a mission that matters.

Intrigued? Learn more at SynapseHealth.com and on Synapse Health's LinkedIn Page

How You'll Contribute

The "Lead Specialist, Member Transitions" will report directly to the Supervisor, Member Transitions. This role is an integral position within the Member Transitions Department, you will be the voice of the company as you interact with our members, prescribers, payors, and vendor network. You will ensure that orders are processed in an accurate, timely, compassionate, and respectful manner. As a Lead Specialist, Member Transition, your primary responsibility is to process Member Transitions to ensure accuracy of all orders, obtain and review qualifying documentation per payor guidelines, obtain any member financial payments, coordinate any vendor equipment transitions, and ensure that the member experience is exceptional through best-in-class service. It is vital that you thrive in a fast-paced environment and embrace change as the company grows and evolves systems and processes.

• Responsible for understanding insurance provider'sdurable medical equipment(DME) guidelines, criteria for services and authorization requirements.
• Maintain excellent working knowledge of current products and services offered by the company.
• Receive and process a high volume of patient/memberDMEtransition files and orders, including but not limited to, order entry, verification of insurance eligibility, retrieving and reviewing all necessary documentation to validate qualification as required by patient/member's insurance payor requirements, obtaining any needed authorizations from payors, patient payment collection, patient scheduling and coordination of care, prescriber and payor outreach and processing of equipment returns, services and exchanges.
• Responsible for coordinating Member Transitions with partner vendors and communicating transition details with members, identified member care team and other internal department team members.
• Provide status on previously submitted pre-authorizations or pre-determination requests.
• Provide accurate information and updates to members, vendors and providers as related to coordinated transitions, new orders, resupplies, pickups services, and exchanges.
• Collaborate with vendors, prescribers, referral sources and Synapse internal departments for assistance or education requests for members.
• Demonstrate professionalism and provide high quality service when interacting with patients, caregivers, and/or referrals.
• Deliver a high-quality patient experience and meet the performance goals established for the position including productivity, call and email quality, member satisfaction, provider satisfaction, vendor satisfaction and other Key Performance Indicators as established by Synapse leadership team.
• Maintain confidentiality of patient/member health information and adhere to HIPAA guidelines.
• Responsible for responding to patient/member concerns, inquiries, requests or questions via telephone, email, chat and within Synapse system platforms with a sense of urgency and advocacy to ensure member's needs are met.
• Demonstrated ability to listen skillfully, collect relevant information, and quickly assess current state and formulate appropriate recommendations to resolve any escalated concerns.
• Flexibility to customize approach to meet all types of communication styles and personalities.
• Comply with all quality, compliance, provider, state and any other regulatory requirements.
• Partner with Training and Quality specialist to mentor and coach transition specialist within the department.
• Represent the transition department on departmental and cross functional projects related to improved customer experience, department efficiencies and elevating the overall employee experience at Synapse Health.
• Work with other department leaders on special tasks and/or projects.
• Provide team management coverage as needed.
• Monitor volume of transitions, any requests or follow up tasks to ensure appropriate workload is balanced across the department.
• Conduct Daily Quick Huddles as needed to discuss important updates, any specific call outs for follow up needed, rebalance workload when appropriate and readily available to assist specialist with any questions.
• Performs other duties as required.