DME Insurance Verification Specialist

Job Description

REQUIREMENTS

• Prior experience working in a DME setting is required.
• Strong knowledge of managed care processes and insurance verification procedures.
• Familiarity with medical coding systems such as CPT and ICD-10 coding is essential.
• Experience handling medical records with attention to detail while maintaining HIPAA compliance.
• Excellent verbal and written communication skills for interacting with insurance companies, healthcare providers, and patients.
• Office experience that demonstrates organizational skills and proficiency with electronic health records (EHR) systems.
• Knowledge of medical terminology and familiarity with dental office or healthcare administrative workflows is a plus.

RESPONSIBILITIES

• Conduct thorough insurance verification for DMEPOS garments by reviewing patient insurance benefits and coverage details.
• Communicate effectively with insurance companies, healthcare providers, and patients to gather necessary information.
• Maintain accurate and up-to-date medical records, ensuring compliance with HIPAA regulations to protect patient confidentiality.
• Utilize medical terminology, CPT coding, and ICD-10 coding systems to interpret and document insurance information correctly.
• Review and process medical documentation, including medical records and notes, to support insurance claims and approvals.
• Collaborate with managed care organizations to confirm eligibility, benefits, and pre-authorizations for DME services via online portals or phone calls.
• Stay informed about changes in insurance policies, managed care protocols, and relevant healthcare regulations to ensure compliance and efficiency.

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