Quality Assurance Specialist, RCM/DME

Tennr•New York, NY

54d•Hybrid

About The Position

We are seeking a Quality Assurance Specialist with a strong background in Revenue Cycle Management and Durable Medical Equipment or Home Medical Equipment processes. This role ensures that every order, documentation set, and workflow meets compliance standards and payer requirements. The person will partner with operations, billing, and customer teams to guarantee accuracy and consistency, and you’ll help translate customer or payer criteria into usable internal references.

Requirements

1-3 years of experience in RCM, DME/HME billing or audit, or order intake/eligibility verification in a healthcare operations setting
Solid working knowledge of HCPCS and ICD-10 coding, payer coverage rules (Medicare/Medicaid/private) and documentation requirements for medical necessity
Experience or comfort with eligibility/benefits verification workflows, insurance coverage checks and prior authorization logic
Strong attention to detail, good analytical/QA mindset, ability to spot inconsistencies and ensure documentation completeness
Good communication skills, able to work with operational/clinical teams and translate requirements into internal guidance

Nice To Haves

Experience with DME/HME order intake in product categories like CPAP, urology, enteral or other durable/home medical equipment
Experience with a billing/RCM system (e.g., Brightree or similar) or working in a healthcare SaaS/tech environment
Familiarity with user acceptance testing (UAT), validation of implementation logic, or working in cross-functional teams (operations + product)

Responsibilities

Review and validate DME and HME orders for completeness, accuracy, correct product ordering, eligibility and documentation of medical necessity
Verify insurance coverage and benefits verification workflows; handle intake through billing with attention to payer policy and documentation standards
Interpret customer or payer-provided documentation, internal SOPs and criteria; translate into structured internal guidance, checklists or reference documents
Collaborate with sales, operations, billing, and implementation teams to ensure alignment between order intake, documentation, and claim submission
Participate in quality assurance audits, identify process gaps or risks, and recommend improvements to streamline workflows and reduce errors/denials
Maintain and update internal policy/reference documents (“source of truth”) for DME/HME coverage, payer rules, HCPCS/ICD-10 mapping, etc.