Remote Prior Authorization Jobs in Portland, OR (NOW HIRING)

DME Order Processing Representative: Part-time

Risen Medical

About the Company

Founded in 2017 as a specialized spine implant distributorship, Risen Medical has grown into a multifaceted medical device company dedicated to improving patient outcomes across the Pacific Northwest. In 2023, the company expanded its offerings and infrastructure to serve a broader spectrum of healthcare needs to include CPAP and other durable medical equipment (DME) solutions.

Risen is patient-first provider serving Oregon, Washington, and Idaho. Our slogan is “We don’t just care, we love.” 

We go above and beyond to help the patient. We will never say “sorry, we cannot help you;” instead, we will say “If we cannot provide this service, we will find some who can.”

1. Patient Service Excellence – Our patients are our number 1 customer. Providing our customers with the highest level of service is why we exist.

2. Innovation – We continually contribute new ideas and solutions that bring about optimal outcomes for our medical providers.

3. Authenticity – We are what you see: transparent in all our business practices; consistent in our actions aligned with our stated beliefs, fostering trust and loyalty with our clients.

Position Overview:

Under the supervision of the Order Operations Manager, the Durable Medical Equipment (DME) Order Processing Representative role is responsible for managing the intake, verification, and processing of patient orders for medical devices such as bracing and CPAP equipment or other DME equipment, ensuring compliance with insurance requirements, and coordinating with healthcare providers and patients.

Key Responsibilities:

• Patient Intake & Documentation Review: Collect and review patient information, medical records, physician orders, and insurance details to confirm eligibility and medical necessity.
• Order Creation & Entry: Prepare and enter clean sales orders for DME products into the NikoHealth order processing platform, ensuring accuracy and adherence to company and regulatory guidelines. Accurately document all patient interactions in NikoHealth. Process and manage Orthofix Bone Growth Stimulator orders in the Stim Connect platform.
• Communication & Coordination: Liaise with patients, physicians, facilities, and insurance representatives to clarify orders, obtain prior authorizations, and resolve issues.  Place Risen Medical introduction call to each new patient within 24 hours of receiving a new order.
• Process Improvement: Identify inefficiencies in order processing and recommend or implement improvements.
• Team Collaboration: Attend meetings, support sales representatives, and work with internal/external team members to ensure smooth order fulfillment 
• Insurance Verification: Confirm active coverage, deductibles, coinsurance, and pre-authorization requirements by contacting insurers or using billing software
• Pre-Authorization Management: Initiate, track, and complete prior authorization requests, notifying all relevant parties of approval or denial 

Technology: 

• EMR Software (NikoHealth) - Training provided.
• Google Suites and Microsoft Office platforms
• iPhone and iPad (IOS) platforms

Required Skills & Qualifications

• Education: Minimum high school diploma or GED
• Technical Skills: Proficiency with Microsoft Office, Google Suite, productivity software, and medical billing systems 
• Communication: Strong written and verbal communication skills for patient and provider interactions 
• Attention to Detail: High accuracy in order entry, documentation, and compliance checks 
• Problem-Solving & Conflict Resolution: Ability to resolve disputes with patients or providers professionally 
• Service Excellence: Ability to deliver on patient service excellence through relationships with patient clients and the management patient schedules. 
• Work Ethic: Ability to work independently and as part of a team, typically 4 hours each day during standard business hours (Mon–Fri, 8:00 a.m.–5:00 p.m.)
• Patient Confidentiality:  Always maintain the confidentiality of patient information, in compliance with all appropriate regulations including but not limited to HIPAA
• Work Experience:  Minimum of six (6) months of health industry experience in a medical office or processing medical claims, and, minimum of six (6) months customer service experience, communicating with customers or patients to include items of a financial nature.

Training and Professional Development: 

• Training: 
• • Complete all internal Risen Medical training requirements to include learning relevant Medicare regulations and company Medicare compliance requirements. 
  • Become proficient in Niko Health billing and management software.
  • Attend and complete all training required to fulfill role requirements
  • Attend and participate in all video teams meetings when scheduled

If you thrive on opportunities to make a meaningful difference in the lives of others and enjoy playing an integral role in their healthcare journey, we invite you to join Risen Medical and apply today.