Customer Specialist

This is a fully remote position, open to applicants in Philippines.

📋 Description

• Conduct timely and accurate eligibility checks and benefit investigations through payer portals and phone outreach to verify insurance and ensure claims are submitted accurately from the outset.

• Enter and monitor DME claims across various platforms, troubleshoot billing issues, and proactively follow up to minimize denials and expedite reimbursement.

• Analyze explanation of benefits (EOBs) for errors, missing payments, or misapplied patient responsibilities, then determine and implement the appropriate resolution path.

• Compose detailed and well-supported appeals that clearly address denial reasons and enhance the likelihood of successful claim recovery.

• Review aging reports weekly to identify unpaid or incorrectly paid claims, collaborating with payers or escalating internally as necessary to drive resolution.

• Provide clear and empathetic responses to patients with billing inquiries, assisting them in understanding their benefits and out-of-pocket costs without confusion.

• Collaborate with Billing teammates, Customer Experience, Fulfillment, and cross-functional partners to identify process gaps and enhance billing operations from start to finish.

• Utilize AI-enabled tools to assist with eligibility, claims validation, and documentation, improving efficiency while ensuring billing accuracy and compliance.

• Ensure timely access to medically necessary DME for families by minimizing billing friction, shortening reimbursement cycles, and ensuring every claim is processed with care.

⛳️ Requirements

• Over 3 years of direct experience in DME billing and insurance reimbursement, managing the complete claim lifecycle from eligibility verification through appeals and collections.

• Confidence in reviewing EOBs, identifying payment discrepancies, denials, and adjustments, and taking appropriate follow-up actions with minimal supervision.

• A solid understanding of CPT, HCPCS, ICD-10, and pertinent DME billing regulations such as HIPAA, CMS, and ERISA, applied accurately in daily work.

• Strong written communication and interpersonal skills, capable of clearly and professionally explaining complex billing issues to patients, internal teams, and payers.

• The confidence to ask questions when uncertain and to flag issues to the appropriate teams.

• Proficiency in CRM/billing software and customer service platforms (NikoHealth, Zendesk, Slack).

• Solid knowledge of cloud-based applications (Google Drive, Google Sheets, Google Docs) and MS Office applications.

• A team-oriented mindset with a keen attention to detail and a proven ability to consistently produce high-quality work, even under high volume.

• Willingness to utilize AI tools that enhance workflow efficiency and accuracy, along with adaptability as new technologies are adopted by the team.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health, dental, and vision insurance.

• Opportunities for professional development and training.

• Flexible work hours and the possibility of remote work.

• Supportive and collaborative team environment.