Order Qualification Representative L1 - Remote (Texas)

Fully Remote • Houston Head Office - Houston, TX 77070

• Position Type: Full Time
• Category: Customer Service

Position Summary: The Order Qualification Representative ensures accurate and timely processing of patient orders for Positive Airway Pressure (PAP) devices by reviewing documentation, verifying insurance requirements, and entering patient information into the electronic medical record system. This role involves collaborating with referral sources and the sales team to obtain missing documentation, providing patients with accurate coverage information, and maintaining current knowledge of insurance policies and workflows. Representatives answer inquiries courteously, meet key performance metrics, and support compliance with all regulatory and company standards. This position is part of a structured job family with four levels: Level 1 manages new orders for all payors, Level 2 handles Bi-PAP/CIM orders, Level 3 processes replacements and supply orders, and Level 4 oversees advanced Bi-PAP orders, administrative responsibilities, and pending documentation follow-up. Advancement is based on demonstrated competencies and business needs.

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)

Qualifications

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.

Essential Skills: To perform the job successfully, an individual should demonstrate the following:

Adaptability - Accepts and applies feedback. Adapts to changes in the work environment. (Different clinical settings, client changes, supervisor changes, etc.). Changes approach or method to best fit the situation within guidelines and direction from supervisor. Manages competing demands. (Prioritizing responsibilities)

Professionalism - Arrives and begins work prepared and on time. Keeps absences within guidelines. Schedules time off in advance. Keeps commitments. Completes tasks within required guidelines. Displays positive outlook, pleasant manner, and professional appearance. Establishes and maintains effective relations. Works actively to resolve conflicts.

Commitment to Quality – Competent in required job skills and knowledge. Displays understanding of how their actions and job affect others. Exhibits ability to learn and apply new skills. Keeps abreast of current developments. Uses resources effectively. Looks for and takes advantage of opportunities. Pursues training and development opportunities. Seeks feedback to improve performance, asks for help when needed. Strives to continuously build knowledge and skills. Seeks increased responsibilities.