Eligibility/Intake DME Processor
About The Position
The Breastfeeding Shop is a family-owned business providing breastfeeding supplies, breast pumps, and accessories. The company is seeking a full-time, detail-oriented Eligibility/Intake DME Processor to join its team in Emmaus, Pennsylvania; remote consideration may be given to well-qualified candidates. The role verifies and processes commercial insurance claims related to durable medical equipment, primarily breast pumps and accessories. It reviews new referrals, verifies patient insurance benefits, obtains required documentation, and ensures DME orders meet payer and regulatory requirements before processing and billing. The position serves as a liaison among patients, physicians, and insurance companies and requires familiarity with major insurers’ verification processes. Orders must be submitted accurately and on time, in compliance with DME guidelines and HIPAA regulations.
Requirements
- High school diploma or GED.
- Experience with prior insurance authorization processes and medical documentation requirements.
- Strong understanding of insurance eligibility verification and benefits investigation.
- Knowledge of DMEPOS products and payer requirements.
- Proficiency with electronic medical records (EMR) and healthcare software.
- Strong analytical and problem-solving skills.
- Excellent written and verbal communication abilities.
- Ability to manage multiple priorities and meet deadlines.
- Strong attention to detail and accuracy.
Nice To Haves
- Associate's degree in healthcare administration, medical billing, or a related field.
- One to two years of DME, medical billing, intake, insurance verification, or healthcare customer service experience.
- Experience with Medicare, Medicaid, and commercial insurance plans.
- Experience with Brightree, Niko Health, Sales Force, or similar healthcare software.
Responsibilities
- Verify patient insurance coverage, benefits, deductibles, co-insurance, and authorization requirements.
- Confirm eligibility through payer websites, portals, and direct communication with payers.
- Determine coverage criteria based on payer-specific policies and guidelines.
- Accurately document verification and benefit information in company systems.
- Receive and review referrals, prescriptions, and supporting documentation.
- Validate physician orders for accuracy, completeness, and compliance.
- Review medical records to ensure documentation supports medical necessity.
- Identify missing information and obtain required documentation from providers and patients.
- Initiate and track prior authorization requests when required.
- Follow up with insurance companies and physician offices regarding pending approvals.
- Maintain complete and organized patient files.
- Ensure documentation meets Medicare, Medicaid, commercial insurance, and accreditation requirements.
- Perform other duties as assigned.
Benefits
- Paid time off.
- Medical, dental, and vision coverage at a shared cost.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
