Remote
Who We Are:
At Synapse Health, we're streamlining the durable medical equipment (DME) process. We manage intake, documentation, routing, claims, billing, and patient support. Our model reshapes how DME is delivered and experienced.
Since 2016, with decades of industry and leadership experience, we've delivered tech-based solutions that help our partners to modernize operations, improve coordination, and reduce administrative burdens. By taking on operational and financial complexity, we're redefining how DME works for providers, prescribers, and patients. We are proud to offer work that matters, on a mission that matters.
Learn more at SynapseHealth.com and on Synapse Health’s LinkedIn.
What We Need:
The Specialist, Member Transitions reports directly to the Manager, Member Transitions and plays a vital role within the Patient Transitions Department. In this role, you serve as the voice of Synapse Health for patients, prescribers, payors, and vendor partners throughout complex transition events. You ensure transitions are executed accurately, efficiently, and compassionately while delivering an exceptional member experience.
As a Specialist, Member Transitions, you are responsible for managing end-to-end transition workflows, including order accuracy, qualification and documentation review, authorization coordination, patient financial responsibility, and vendor equipment transitions. You thrive in a fast-paced, high-volume environment and embrace change as systems, processes, and programs evolve to support organizational growth.
What You Will Do: Maintain a strong working knowledge of insurance provider DME guidelines, coverage criteria, and authorization requirements.
Maintain familiarity with Synapse Health products, services, and transition workflows.
Manage a high volume of patient/member transition files and DME orders, including:
Order entry and validation
Insurance eligibility verification
Retrieval and review of qualifying clinical documentation per payor guidelines
Authorization and pre-determination coordination
Patient financial responsibility collection
Scheduling, care coordination, and prescriber/payor outreach
Processing equipment returns, exchanges, and service transitions
Coordinate member transitions with partner vendors and communicate transition details with members, care teams, and internal departments.
Provide timely updates on authorization status and transition progress to members, vendors, and providers.
Deliver accurate information related to new orders, resupplies, pickups, services, and exchanges.
Collaborate with vendors, prescribers, referral sources, and internal teams to resolve transition issues and support education needs.
Demonstrate professionalism and deliver high-quality service when interacting with patients, caregivers, and referral partners.
Meet or exceed established performance goals, including productivity, call and email quality, member satisfaction, provider satisfaction, vendor satisfaction, and other KPIs.
Respond to patient/member concerns, inquiries, and requests via phone, email, chat, and internal systems with urgency and advocacy.
Listen effectively, gather relevant information, and assess situations quickly to recommend appropriate solutions for escalated concerns.
Adapt communication style to meet the needs of diverse personalities and communication preferences.
Ensure compliance with all quality, regulatory, payor, and state requirements.
Represent the Patient Transitions Department on cross-functional initiatives focused on customer experience, operational efficiency, and employee engagement.
Partner with department leaders on special projects and process improvement initiatives.
Participate in an on-call rotation to support after-hours member requests.
Perform additional duties as required to support team and organizational objectives.
What You Have:
At Synapse Health, we’ve intentionally built a culture rooted in kindness, collaboration, and creativity,…