Quality Specialist

Equal Opportunity Employer/Disability/Veterans About Reliable Respiratory

Reliable Respiratory is a Durable Medical Equipment (DME) company that provides the highest quality level of service for patients in need of respiratory, diabetes, urology, and maternity support. Equipment provided includes, CPAPs, BiPAPs, AutoPAPs, nebulizers, oxygen equipment, ventilators, CGM devices, insulin pumps, and breast pumps.

Each patient is treated with professionalism, understanding, and attentive service. We care about our customers, work closely with the medical community, and have highly skilled staff ready to assist customers in receiving the best care possible.

The Quality Specialist reviews patient charts and sales orders to ensure information, documentation, prior authorization, and patient eligibility are met to achieve successful payment of claims while providing exceptional service to our patients and their families, payors, providers and team members.

• Provide exceptional service every time.
• Meet or exceed annual performance indicators as outlined by organizational leadership.
• Complete assigned tasks and worklists in a timely manner.
• Ensure patient charts are accurate and have all the necessary information.
• Ensure sales orders are accurate and have all the necessary information.
• Update patient insurance policies and adjust sales orders as needed.
• Work with product line teams, providers and patients to obtain necessary and current patient information and medical documentation to ensure timely processing of sales orders.
• Verify patients’ insurance eligibility, including contacting payors to investigate and verify the terms and benefits of patients’ insurance policies and costs.
• Perform basic billing functions including but not limited to credit adjustments and recalculation of billing dates of service to ensure sales orders bill correctly.
• Work with providers and patients to help them understand requirements for payor coverage including but not limited to:
  • Authorization and compliance requirements
  • Appeals for denied services / claims
• Evaluate and/or escalation patient accounts that do not meet insurance or provider guidelines.
• Stay up to date on insurance guidelines and their authorization and billing requirements.
• Actively participate in meetings as necessary.
• Perform other duties and special projects as assigned and directed.

• 18 years of age or older
• Must be eligible to work in the United States and not require work authorization from us now or in the future
• Associate’s degree required or 2 years of relevant (authorization, claims, quality or billing) experience

• Demonstrates effective problem solving.
• Listens attentively to people’s ideas and concerns.
• Makes decisions in a timely manner when the options are clear and there is little pressure or risk.
• Maintains balance through unexpected circumstances.
• Acts without being asked or required to do so.
• Exercises excellent judgment in all aspects of the execution of job duties.
• Effective and professional verbal and written communication abilities.
• Seeks to improve in all aspects of work performance.
• Responds to internal and external inquiries in a timely manner.
• Excellent customer service skills; especially in high intensity situations
• Strong attention to detail.
• Proficient in the use of computer applications (especially Microsoft Office Suite).
• Ability to work independently.
• Ability to work in collaboration with others.
• Ability to prioritize and complete work amidst interruptions in a busy work area.
• Ability to comply with internal and industry-imposed guidelines/regulations

• Customer Service
• Ethics
• Organization Skills
• Productivity
• Results Driven
• Computer Skills

The physical…