[Hiring] Member Transitions Specialist @Synapse Health

Role Description

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
• 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.

Qualifications

• 2+ years of recent experience in the durable medical equipment (DME) industry, including customer service, qualifications, logistics, patient transitions, or related roles.
• Proficiency in 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.

Requirements

• 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.

Benefits

• Professional growth opportunities with 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 plan with employer matching contributions

Compensation

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