DME Intake - Patient, Insurance, and Documentation Specialist

Valgorithm • Fort Lauderdale, FL

37d

About The Position

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.

Requirements

• 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

Nice To Haves

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

Responsibilities

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

Benefits

• Make an immediate and meaningful impact by helping ensure patients receive timely, compliant access to essential medical supplies
• Play a direct role in supporting not only the company’s success, but the health and well-being of the community we serve
• Join a growing organization with clear opportunities for professional growth as the company continues to scale
• Be part of a collaborative, team-oriented work environment where your expertise and contributions are genuinely valued
• Work closely with leadership in an organization that prioritizes compliance, quality, and employee support

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed