DME Documentation Specialist

The DME Documentation Specialist must be knowledgeable of all equipment and supplies provided by Home Medical and uphold its standard for excellence. Responsible for processing orders for various medical equipment. Experience in durable medical field preferred specifically insurance and medical terminology. Responsible for competently and efficiently performing all tasks relative to the order intake process in a friendly, professional manner.

Responsibilities:

• Collects, reviews and requests medical documentation required to support medical necessity to submit for Prior Authorization.
• Submits and maintains prior authorizations and all certificates of medical necessity (CMN)
• Requests documentation to support medical necessity and ongoing need for various durable
• medical equipment items including and not limited to oxygen and sleep therapy.
• Creates initial, revised and recertification certificates of medical necessity within various
• DME billing software systems.
• Reviews incoming CMN’s and medical records for accuracy.
• Reviews and completes stop hold reports to resolve and release held revenue to various
• payers.
• Knowledgeable of Medicare, Medicaid and other insurance companies’ rules regarding
• CMN’s, detailed written orders and prior authorizations.
• Ability to converse with clinicians and office staff to follow up on outstanding requests and to
• describe information required.

Qualifications:

• Minimum of 1 year of experience in durable medical billing requirements.
• Understanding Durable Medical Equipment intake processes including insurance verification, and Prior Authorization Requests.
• Experience working in DME billing platform – Brightree.
• Knowledge of requirements for Medicare, Medicaid, and Commercial payers as for what
• qualifies a patient for coverage of prescribed equipment.
• HS diploma/GED.
• Knowledge of documentation requirements for multiple HCPCs.
• Strong computer skills including MS Word, Excel and strong keyboarding skills.
• Proven ability to use formal business language to communicate effectively in written form
• including spelling and punctuation.
• Strong attention to detail.
• Task oriented while performing in a fast-paced environment.
• Results-oriented self-starter with a can-do attitude.
• A sense of urgency and ability to complete tasks in a timely manner.
• Proven ability to review current processes and procedures and suggest process improvements or solutions.
• Able to work with others with diverse personalities.
• Good problem-solving skills including managing crisis situations calmly and professionally as well as the ability to maintain confidential patient, financial and company information. following HIPAA guidelines.

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