Medical Reviewer Specialist– Team Lead (Rx Processing & Calling)

Role Overview

The Healthcare Review Specialist / Team Lead is responsible for end-to-end prescription (Rx) processing review and calling activities related to Durable Medical Equipment (DME). This role combines hands-on prescription data review provider/patient calling and team-level oversight to ensure accuracy compliance and timely fulfillment of prescriptions. The position requires strong medical knowledge familiarity with U.S. insurance requirements and the ability to interact professionally with customers agents and medical offices while ensuring HIPAA compliance and service quality.

Rx Processing & Review

• Review and verify prescription orders received via multiple channels (portal email fax e-commerce platforms such as Magento and other intake methods).
  

• Validate prescription details including drug/DME item dosage usage instructions (SIG) refills diagnosis codes and prescriber information.
  

• Ensure prescriptions meet U.S. insurance and payer-specific requirements before processing.
  

• Accurately enter and update verified Rx data in internal systems and workflows.
  

• Cross-check physician NPI ICD diagnosis codes and supporting documentation for accuracy and completeness.
  

Rx Calling & Communication

• Perform and oversee outbound and inbound Rx-related calls to:
  

  • Physician offices for prescription clarifications or missing information
    

  • Customers/patients for order-related follow-ups
    

  • Pharmacies or vendors as required
    

• Communicate using appropriate medical terminology while maintaining professionalism and empathy.
  

• Document call outcomes clearly and update systems in real time.
  

• Follow defined calling scripts SOPs and compliance guidelines.
  

Team Lead & Escalation Support

• Act as a Team Lead for Rx data entry and calling activities.
  

• Support agents by handling escalations clarifying medical or process-related queries and providing guidance.
  

• Review team output for accuracy completeness and SLA adherence.
  

• Participate in client meetings address operational concerns and provide updates on daily activities.
  

Compliance & Quality

• Maintain strict HIPAA compliance and data confidentiality at all times.
  

• Identify process gaps errors or compliance risks and recommend corrective actions.
  

• Support quality audits and continuous process improvements.
  

Reporting & Administration

• Prepare and manage daily weekly and monthly operational reports.
  

• Track productivity quality metrics and turnaround times.
  

• Perform additional administrative or operational tasks as assigned by leadership.
  

Qualifications & Skills

• Graduate / Allied Health Professional preferably with a science or healthcare background.
  

• 13 years of experience in the U.S. healthcare domain (Rx processing DME insurance operations or healthcare customer service).
  

• Strong understanding of:
  

  • Prescription formats and Rx workflows
    

  • U.S. insurance and payer requirements
    

  • HIPAA and healthcare compliance standards
    

• Experience in Rx calling or provider/patient communication is required.
  

• Excellent written and verbal communication skills.
  

• Strong attention to detail and analytical ability.
  

• Proficiency in Excel and comfort with reporting and data analysis.
  

• Ability to manage escalations and lead by example.
  

Shift Details

• U.S. Shift (Evening/Night): 4:30 PM 1:30 AM IST
  

Role Focus Summary

• Rx Processing & Review
  

• Rx Calling support (Providers / Patients / Pharmacies)
  

• Team Lead & Escalation Handling
  

• Compliance Quality and Client Interaction