Customer Care Specialist - Pensacola, FL

In-Office Requirement: This position is based on-site at our Pensacola, FL location. Employees are expected to work in the office during standard business hours, with regular in-person collaboration as a key component of the role. 

Job Summary:

Under general supervision, the Customer Care Specialist serves as a critical point of contact for patients, caregivers, clinicians, and referral partners with Wellspect’ product portfolio.  The role is responsible for accurately processing product orders, verifying insurance and documentation requirements, coordinating with internal and external stakeholders, and delivering a high-quality service experience that supports optimal patient outcomes.  The Customer Care Specialist ensures all activities adhere to regulatory, payer, and compliance standards while demonstrating professionalism, efficiency, and compassion in every interaction.

Key Responsibilities:

Insurance, Documentation & Compliance:

• Reviews prescriptions, certificates of medical necessity, and supporting clinical documentation to ensure full compliance with payer guidelines, DME requirements, and regulatory standards.
• Validates diagnosis codes, product categories (e.g., catheters, drainage supplies), and utilization justification for accuracy and completeness.
• Maintains a thorough understanding of urology-related billing protocols, medical necessity criteria, and insurance verification processes.

Customer Interaction & Service Excellence:

• Engages with patients, caregivers, clinicians, and referral partners with empathy and professionalism to facilitate a seamless ordering experience.
• Educates patients on product availability, financial responsibility, recurring shipment schedules, and documentation requirements in a clear and supportive manner.
• Addresses and resolves product-related or service-related inquiries, ensuring timely escalation when necessary.

Collaboration & Cross-Functional Coordination:

• Partners closely with Sales, Clinical Education, Billing, and Supply Chain teams to streamline order flow, resolve discrepancies, and ensure alignment with urology product standards.
• Communicates proactively with external referral sources (urologists, nurse practitioners, home health agencies) to obtain missing or corrected documentation.
• Serves as the internal advocate for the patient and customer, ensuring efficient problem resolution and continuity of care.

Order Processing & Fulfillment Management:

• Enters, modifies and tracks patient orders received via phone, email, fax, EDI, or other channels, accurately and efficiently.
• Ensures orders comply with insurance coverage guidelines, medical necessity standards, and internal quality protocols.
• Monitors order progress, updates stakeholders, and ensures timely fulfillment to prevent disruptions in essential urology supply usage.

Lead Qualification & Conversion:

• Reviews all incoming leads, assess eligibility, and convert qualified leads into compliant and billable orders.
• Maintains a structured follow-up cadence to maximize conversion rates and ensures no lapse in patient care or revenue opportunity.
• Partners with internal teams to support patient retention, reorder patterns, and long-term utilization of urology solutions.

Documentation, Reporting & Data Integrity:

• Maintains accurate and complete records of documentation requests, order statuses, complaint resolutions, and communication touchpoints.
• Produces routine reports to management on order accuracy, lead conversion metrics, complaint trends, and overall service performance.
• Adheres to HIPAA guidelines and internal confidentiality standards at all times.
• Complies with company and departmental policies and administrative requirements.
• Performs other duties as assigned or as needed.

Education/Certifications: 

• Minimum: High School Diploma or equivalent
• Preferred:  Certified Medical Assistant (CMA) or Associate’s degree in Healthcare Administration, Business, or a related field
• Additional certifications in medical billing, insurance claims processing, or healthcare administration are advantageous

Years and Type of Experience

• 2+ years of customer service experience analyzing and solving customer problems
• Preferred: 2+ years of inside sales, referral management, or lead conversion experience within healthcare
• Experience working in DME, medical device, or healthcare customer service, preferably supporting urology, ostomy, or chronic care patient populations
• Clinical experience as a Medical Assistant, CAN, or similar role preferred; urology or continence care exposure is highly desirable
• Knowledge of medical terminology, especially urology-related coding, diagnoses, and product categories is a plus

Key Skills, Knowledge & Capabilities:

• Proficiency with Microsoft Office Suite (Word, PowerPoint, Outlook, and Excel), CRM systems, order management platforms, and electronic documentation systems.
• Strong understanding of payer requirements, prior authorizations, DME billing practices, and reimbursement models.
• Ability to build and maintain productive relationships with both internal and external stakeholders, including clinical partners, referral sources, and patients.
• Exceptional communications, organization, and follow-through skills with the ability to manage a high volume of requests.
• Demonstrated ability to remain calm, empathetic, and patient-focused while navigating sensitive clinical topics.
• Ability to work independently, manage competing priorities, and maintain accuracy in a fast-paced environment.

Key Performance Metrics:

• Documentation Timeliness: Ability to secure compliant documentation quickly to avoid delays in product delivery.
• Order Accuracy: High accuracy rate with minimal rework, corrections, or rejected claims.
• Complaint Resolution: Effective and timely resolution resulting in high customer satisfaction and reduced service escalations.
• Lead Response Time: Timely initial contact and follow-up on all patient or referral leads.
• Lead Conversion Rate: Strong conversion of qualified leads into compliant, billable, and ongoing orders.