Member Transitions Specialist

Synapse Health; United States; Remote; USD 23,000 - 29,000; Full time

Benefits offered by this job

PTO

Medical, Dental, Vision

401(k) with employer match

Career growth opportunities

Job summary

Synapse Health is seeking a Specialist, Member Transitions to serve as the voice for patients, prescribers, payors, and vendors during complex transition events. This role focuses on accurate, efficient, and compassionate execution of end-to-end transitions within the Patient Transitions Department.

You will handle order accuracy, eligibility verification, documentation review, authorizations, scheduling, care coordination, and vendor communications, while aiming to exceed KPIs and deliver an

Qualifications

• 2+ years of recent experience in the DME industry.
• Proficiency in Microsoft Office apps and quick learning of systems.
• Strong organizational and communication skills.
• Ability to manage high-volume workflows with accuracy.
• Compliance with quality and regulatory requirements.

Responsibilities

• Maintain knowledge of insurance DME guidelines and authorization requirements.
• Manage high-volume patient transitions and DME orders.
• Verify insurance eligibility and review qualifying documentation.
• Coordinate authorizations and patient financial responsibilities.
• Communicate transition updates to members, vendors, and care teams.
• Collaborate with vendors and providers to resolve issues.
• Meet performance goals including productivity and satisfaction KPIs.
• Participate in on-call rotation.

Skills

Customer service

Organization

Verbal and written communication

Analytical and problem-solving

Attention to detail

Tools

Microsoft Office

Job description

Who We Are:

At Synapse Health,we’restreamlining the durable medical equipment (DME) process.We manage intake, documentation, routing, claims, billing, and patient support. Our model reshapes how DME is delivered andexperienced.

Since2016,with decades of industry and leadership experience,we’vedelivered tech-based solutions that help our partners to modernize operations, improve coordination, and reduce administrative burdens. By taking on operational and financial complexity,we’reredefining how DME works for providers, prescribers, and patients.We are proud to offer work that matters, on a mission thatmatters****.

Learnmore at_SynapseHealth.comand onSynapse 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, youare responsible for managing end-to-end transition workflows, including order accuracy, qualification and documentation review, authorization coordination, patientfinancial 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
• Patientfinancial responsibilitycollection
• 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.
• Providetimelyupdates on authorization status and transition progress to members, vendors, and providers.
• Deliveraccurateinformation 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 solutionsfor 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-hoursmember requests.
• Performadditionalduties asrequiredto support team and organizationalobjectives.

What You Have:

At Synapse Health,we’veintentionally built a culture rooted in kindness, collaboration, and creativity, qualities we consider essential for every team member.Additionalrequirements include:

• 2+ years of recent experiencein the durable medical equipment (DME) industry, including customer service, qualifications, logistics, patient transitions, or related roles.
• Proficiencyin Microsoft Office applications and the ability to quickly learn department- and role-specific systems.
• Strong organizational skills with the ability to manage complex, high-volume workflows.
• Effective verbal and written communication skills across multiple audiences.
• Strong analytical and problem-solving abilities to navigate complex transitions and resolve issues.
• High attention to detail and a strong commitment to accuracy and compliance.
• Availability to work between 8:00 a.m. and 8:00 p.m. EST, with potential participation in an on-call rotation.

What Sets You Apart:

• Strategic Thinker:Understands the broader transition lifecycle andanticipatesdownstream impacts.
• Adaptable: Responds quickly to change andembracenew processes, systems, and workflows.
• Analytical:Breaks down complex information to draw clear, actionable conclusions.
• Sound Decision-Maker:Exercises good judgment in high-pressure or complex situations whilemaintaininga patient-first mindset.

Compensation:

The pay range for this position is $17 – $21 per hour. This range reflects theanticipatedcompensation at the time of posting. Final compensation will be based on factors such as relevant experience,demonstratedskills, internal equity, and prevailing market conditions. Compensation discussions are encouraged throughout the hiring process.

What Sets Us Apart:

Work is a part of life,but at Synapse Health, we believe it should be meaningful and enjoyable.We’recommitted to helping our team members thrive personally and professionally, which is why our benefits include:

• Professional growth opportunitieswith compelling career paths
• Healthy work-life balance supported by generous paid time off (PTO)
• Comprehensive benefits package, including medical, dental, vision, STD&LTD insurance for full-time team members
• 401(k) savings planwith employer matching contributions

Synapse Health is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.

Synapse Health, Inc will never request personal or sensitive information during the recruitment process. Please see our Careers Page for more information to protect yourself from scammers and to learn more about our recruitment process.

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