DME Intake - Patient, Insurance, and Documentation Specialist

Position Summary

The Intake, Documentation & Insurance Verification Specialist is responsible for ensuring all patient orders are complete, compliant, and financially clear prior to fulfillment. This role owns the front-end accuracy of the patient lifecycle—intake, documentation, insurance verification, and resupply readiness—ensuring clean handoffs to billing and long-term patient success. This position is for a seasoned DME professional who understands payer rules, CMS documentation standards, and how strong intake directly impacts billing, compliance, and patient satisfaction.

Patient Intake & Referral Management

• Receive, review, and process incoming referrals from physicians and healthcare partners
• Validate referrals for completeness, medical necessity, and payer requirements
• Obtain and verify patient demographics, diagnoses, and insurance information
• Communicate with referral sources to resolve missing or incorrect documentation

Documentation & Compliance

• Collect, review, and maintain physician orders, CMNs/LMNs, and supporting medical records
• Ensure documentation meets CMS, Medicare, and payer-specific standards prior to fulfillment
• Maintain organized, audit-ready patient records within NikoHealth
• Follow SOPs and documentation checklists to prevent downstream billing issues
• Proactively identify and resolve documentation gaps before escalation

Insurance Verification & Patient Financial Responsibility

• Verify Medicare and secondary insurance eligibility and benefits
• Confirm coverage criteria, frequency limitations, and authorization requirements
• Accurately determine patient out-of-pocket responsibility, including deductibles and coinsurance
• Clearly and professionally explain coverage details and financial responsibility to patients
• Document insurance verification and patient cost discussions in the system

Resupply Coordination

• Support track resupply eligibility based on payer guidelines
• Ensure updated documentation and continued medical necessity are on file for resupply
• Carefully coordinate with billing and RCM teams to support clean resupply claims
• Maintain accurate resupply notes, follow-ups, and task tracking

Team Collaboration & Cross-Functional Support

• Work closely with billing, RCM, and resupply teams to ensure end-to-end workflow accuracy
• Provide cross-coverage support during high-volume periods
• Act as a team player who understands how intake, verification, resupply, and billing impact one another

30-60-90 Day Success Plan

• First 30 Days: Systems & Accuracy
• Learn ease of DME payer mix and end-to-end revenue workflows
• Understand Medicare vs. Medicare Advantage vs. Commercial payer rules
• Submit and track claims under supervision to understand downstream impacts
• Review common denial and adjustment reasons tied to intake and documentation gaps
• Achieve 90% claim accuracy on supported workflows

• Days 31-60: Ownership & Control
• Independently manage assigned intake, documentation, and verification workflows
• Support denial prevention by ensuring clean, compliant front-end documentation
• Coordinate closely with billing on root causes tied to documentation or eligibility
• Maintain accurate tracking and timely follow-up on outstanding items
• Contribute to a 20% reduction in preventable denials through improved intake quality

• Days 61-90: Optimization & Scale
• Fully own front-end revenue readiness for assigned payors
• Identify payer behavior trends that impact documentation, eligibility, or coverage
• Improve clean-claim and first-pass payment performance through intake accuracy
• Support appeals and recoupment defense with audit-ready documentation
• Maintain 95%+ clean-claim submission rate through strong intake controls

Required Skills & Qualifications

• 2-5 years of DME intake, documentation, or insurance verification experience
• Strong knowledge of Medicare, CMS documentation standards, and payer guidelines
• Experience with NikoHealth or similar DME management systems
• Ability to confidently explain insurance benefits and out-of-pocket costs to patients
• Highly detail-oriented and process-driven
• Strong communication and organizational skills
• HIPAA-compliant and professionalism-focused

Preferred Experience

• Experience with urological supplies and/or CGM (Continuous Glucose Monitoring)
• Prior exposure to documentation reviews, audits, or payer requests