Skilled Intake Specialist – Healthcare

JOB OVERVIEW

We are looking for highly motivated and hard-working candidates to fill the Full-Time position of Intake Specialist for our Healthcare Account.

Open Roles:

KEY RESPONSIBILITIES

Responsibilities span across all three roles and include the following core functions:

Insurance Verification

• Perform full insurance benefits verification for new DME patients (urology, ostomy, catheter) via portal and phone
• Verify the accuracy of insurance information and HCPC codes entered into patient accounts
• Contact insurance carriers by phone when portal verification is unavailable or incomplete
• Document all verification results in the system and route to the appropriate teams for processing
• Identify and flag insurance discrepancies, eligibility issues, or prior authorization requirements

Prior Authorization

• Manage end-to-end prior authorization lifecycle for urology, ostomy, and catheter DME orders
• Collect required clinical documentation from referral sources, physicians, and internal teams
• Submit authorization requests to payers via portal, phone, or fax per payer requirements
• Track authorization status and proactively follow up to ensure timely turnaround
• Initiate re-authorization for existing patients ahead of reorder dates and communicate outcomes to CSR and clinical teams
• Flag denials, peer-to-peer requests, and appeals to appropriate internal contacts
• Support Workers’ Compensation authorization workflows as the scope expands

Reverification & Overflow Support

• Perform insurance reverifications for existing patients flagged due to coverage changes
• Identify coverage discrepancies and update patient accounts with corrected insurance information
• Monitor and work the daily reverification queue, routing accounts to appropriate teams
• Provide overflow support for new patient insurance verification during high-volume periods
• Flag patterns in insurance change activity that may indicate seasonal volume spikes
• Maintain accurate documentation and notes for every verification and reverification interaction

REQUIRED QUALIFICATIONS

• Minimum 3 years of experience in US medical insurance verification, prior authorization, or RCM — REQUIRED
• Prior Authorization (PA) and Insurance Verification (IV) experience — REQUIRED
• Healthcare experience — REQUIRED
• Working knowledge of US payer portals (Availity, NaviMed, UHC, BCBS, Cigna, etc.)
• Familiarity with HCPC codes and DME billing requirements, including ostomy and catheter products
• Experience handling Medicare and Medicare Advantage plans
• Strong English communication skills — written and verbal (phone calls to US payers required)
• Ability to manage multi-stage caseloads with concurrent active authorizations
• Familiarity with insurance change workflows, COB (coordination of benefits), and plan terminations
• Close attention to detail and the ability to maintain quality under volume pressure
• Comfortable working US Eastern Time hours remotely from any location

PREFERRED QUALIFICATIONS

• Experience in DME, urology, ostomy, catheter, home health, or specialty medical billing
• Familiarity with Medicare Advantage and MCO authorization requirements
• Workers’ Compensation authorization experience
• Experience with clinical documentation portals and EMR/CRM systems used in US DME operations
• Prior authorization support experience, including document collection and status tracking
• Familiarity with open enrollment periods and the US insurance change seasonality
• Experience working with US healthcare clients via BPO or offshore staffing

Home Office Requirements: (must provide screenshot)

• Stable internet connection with at least 100 Mbps postpaid
• Computer (at least 16GB RAM and Intel i5 core processor equivalent or up)
• Noise-Cancelling Headset
• Backup Internet Connection (Prepaid Home WIFI Router or Pocket WIFI) and Power Outage Backup
• Dual Monitor

Benefits:

• Competitive compensation
• Monthly Company Bonus Program
• Paid Vacation Leave
• Healthcare Insurance
• PhilHealth Insurance
• Internet Allowance
• Holiday Bonus
• Work Environment & Growth
• 100% remote work — work from anywhere with a stable internet connection

Required for consideration:

• Screenshot of your present ISP speed results via speedtest.net.
• Screenshot of your computer/laptop specs.