SUMMARY:

The ISR/Internal Sales Representative is responsible for benefit verification, negotiation, and/or pre-authorization processing of contracted payors, group health, managed care, workers’ compensation, personal injury and/or governmental payor patient referrals consistent with corporate policy and procedure. The essential responsibilities are typically a variety of projects of significant scope and complexity, difficult, & demanding, and the incumbent may be required to apply specialized knowledge of functional areas to modify existing methods, solve problems, and complete tasks. Work is typically performed under general direction.  Work is subject to periodic review upon completion and is typically performed under general direction.

Essential Duties and Responsibilities:

  • Demonstrate a commitment to continuous improvement to ensure efficient flow of all orders.
  • Work new orders (all orders received by 1:00pm PT should be worked same day if Monday-Friday and not including holidays) All orders must be worked within 48 hours with the exception of orders received on weekends.
  • Review and re-confirm that all medical records, prescriptions, etc. submitted with patient orders for appropriateness; to ensure they meet the company guidelines & payor standards for documentation of medical necessity.
  • Increase authorization percentage and potential for payment &/or positive litigation outcome by ensuring all necessary documentation to support medical necessity is secured.
  • Insurance/Benefit verification.
  • Pursue pre-authorizations on all orders where solid medical necessity is present.
  • Demonstrate the ability to develop & maintain positive professional relationships and aggressively and effectively negotiate for authorization with payors.
  • Call the adjustor to confirm the claim is active, body part accepted body part, who the preferred vendor is, fax, phone, or email is confirmed, and claims address, are there any particular documents required or need to be submitted.
  • Responsible for electronic processing of contracted group health, managed care, workers’ compensation, personal injury and/or governmental payor patient referrals.
  • Demonstrate the ability to develop & maintain a positive professional relationships and effective, efficient communications with Patient.
  • Complete introductory call within 24 hours of receipt of order to initiate communication and set authorization, benefit, co-pay & timeline expectations with the patient.
  • Emphasize product features and benefits, quote prices, and discuss payment options for cash sales.
  • Discuss insurance coverage, deductible amounts and customer financial responsibility for products with third-party reimbursement.
  • Coordinate (with patient) specialized co-payment, deductible, and other out-of-pocket payment plans; and, where the original product ordered is not compensable under the patient’s benefit plan, when applicable.
  • Responsible for completion calls to 100% of patients to inform them that their order is authorized or is being moved forward and is ready for shipping or fitting.
  • Conduct a complete review of documents to assure we have everything needed to bill product/claim.  
  • Assist with other assignments or special projects, as required.
  • Maintain broad familiarity of all company practices, procedures, policies and job tasks.
  • Maintain advanced knowledge of VQ OrthoCare products, cash pricing, payment options and third-party durable medical equipment reimbursement.
  • Ensure that management receives the appropriate information as required for monthly analysis and reporting with respect to all Inside Sales Department activities and other measures of productivity as required.
  • Implement process improvements to ensure department and company goals are being met in an efficient, timely, and professional manner.
  • Develop & interpret policies, practices, and process improvements that may impact assigned department, subject to Sr. Management review.
  • Self-determine goals and methods to align them with current company strategies.
  • Display orientation to profitability and work within approved budget.
  • Understand that failure to achieve goals may result in significant schedule delays and/or added cost or resource allocations.
  • Stay up-to-date with current industry and third-party reimbursement changes and trends.
  • Update Payer Relations department with insurance contracting opportunities.
  • Follow Company policies and procedures to support the goals and objectives of the Company.
  • Maintain ethical behavior in the workplace as defined in the company policies & procedures and employee handbook.
  • Interpret and accept instruction, direction, and coaching from direct supervisor.
  • Handle internal and external communications with tact, diplomacy, and discretion.
  • Interact effectively, appropriately, and professionally with, staff, peers, all levels of management, customers, vendors & visitors.
  • Interface regularly with Outside Sales departments to follow up on customer orders, etc.
  • Effectively present information and respond to questions from external customers, supervisors, leads, co-workers & other staff regarding cross-functional or long-term projects or goals.
  • Handle high to moderate stress in a professional manner.
  • Demonstrate the ability to develop & maintain a “sales mentality” by increasing understanding how to communicate the benefit s of our products in order to improve customer satisfaction and reduce cancel rates.
  • Demonstrate the ability to develop & maintain a positive professional relationships with external customers, including clinicians, and sales team.
  • Assists with other assignments or special projects, as required.
  • Maintain broad familiarity of all company practices, procedures, policies and job tasks.
  • Maintain advanced knowledge of VQ OrthoCare products, cash pricing, payment options and third-party durable medical equipment reimbursement.
  • Conduct follow ups daily with patients, providers, and the sales teams to ensure a positive work flow and keep the orders moving. 

Competency:

  • Job Specific Duties: To appropriately and effectively support the function and activities of the Sales Department.
  • Job Knowledge & Business Acumen: To maintain broad familiarity with all company and department policies, practices, procedures, product knowledge, industry trends and job tasks to complete critical or complex projects, resolve problems and/or initiate process improvement strategies. 
  • Communication and Ethics: To appropriately and ethically represent the company and initiate actions and/or communications which will best serve the interests of VQ OrthoCare.

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 accommodations may be made to enable otherwise qualified individuals with disabilities to perform the essential functions

Technical Skills:

  • Highly proficient in software such as Word, Excel, PowerPoint and other standard MS Office Programs
  • Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, decimals, and percentages
  • Read and interpret general business periodicals, professional journal, technical procedures, or governmental regulations
  • Organize and prioritize tasks as needed to perform job within pre-established time-management standards.
  • Plan and organize time to support the staffing needs of the department, company policy and state & federal labor requirements.
  • Align work with performance goals.
  • Accurately perform keyboard functions at a minimum of 30 wpm.
  • Edit work for accuracy, spelling & grammar & present numerical data effectively.

Education/Experience:

  • Associate’s Degree preferred
  • Additional 2+ years related experience or equivalent of education plus directly related education, training and experience
  • Preferred experience includes data entry and customer service experience in healthcare workplace environments.

Physical and Mental Demands:

  • Typically interacts with staff, peers, senior management and external customers
  • Ability to handle moderate to high stress
  • Regularly required to sit, stand, move about, stoop, bend, reach, finger and grasp and to move and/or lift up to 20 pounds
  • Regularly must see and read computer displays and reports, PDA displays & cell phone displays
  • Must regularly type and or enter data using computer keyboards.

Certificates and Licenses:

  • No special certificates, licenses or registrations are required

Supervisory Responsibilities:

The job has no supervisory responsibilities.

Work Environment:

Reasonable accommodations may be provided in order to allow qualified individuals with disabilities to perform the essential duties and tasks.

The work environment varies between that of a typical office setting with controlled temperature and humidity and a typical automobile interior, traffic and noise associated with commuting, along with typical patient home environments for short durations. Ambient noise levels are consistent and generally low to moderate.