[Remote] DME Benefit Verification Specialist

Note: The job is a remote job and is open to candidates in USA. Compression Care, LLC is a leading national provider of Durable Medical Equipment (DME), committed to delivering high-quality products and exceptional service to our patients. The Benefit Verification Specialist will be responsible for verifying patient insurance benefits related to DME, ensuring accurate documentation, and facilitating the authorization process to guarantee timely patient access to necessary equipment.

Responsibilities

• Insurance Verification: Review patient insurance information to determine coverage for Compression Garments
• Benefit Analysis: Verify patient-specific benefits, including coverage details, cost-sharing responsibilities, and provider access options, adhering to program-specific standard operating procedures (SOPs)
• Authorization Coordination: Initiate and manage prior authorization requests, including documentation and follow-up with insurance payers
• Documentation: Accurately document all verification and authorization activities in the electronic medical record (EMR) system. Azalea and a proprietary system are the two we use most often. Send pre-filled prescription requests to physicians
• Communication: Collaborate with referral sources, healthcare providers, and internal departments to gather required information for benefit verification and respond with benefit information to patients and referral sources
• Compliance: Ensure all activities comply with HIPAA regulations and company policies
• Reporting: Identify and report coverage trends or delays to management
• Continuous Improvement: Participate in training sessions and stay updated on changes in insurance policies and procedures

Skills

• Minimum of 1 year in durable medical equipment insurance verification, with knowledge of DME products, billing, coding, and terminology
• High school diploma or equivalent required; associate degree or higher in a related field preferred
• Proficiency in EMR systems and Microsoft Office Suite
• Familiarity with insurance verification tools such as Availity, CGS, and an understanding of various payer requirements
• Strong knowledge of insurance processes, including Medicare, Medicaid, and commercial payers
• Strong verbal and written communication skills
• Excellent organizational skills with attention to detail
• Ability to work in a fast-paced environment and adapt to changing procedures and regulations
• Certified Medical Reimbursement Specialist (CMRS) or Certified Medical Insurance Specialist (CMIS) credentials
• Prior experience with Lymphedema and the LTA
• Knowledge of HIPAA regulations and patient confidentiality standards

Benefits

• Health, dental, and vision insurance
• 401(k) with company match
• Paid time off and holidays
• Opportunities for professional development and career advancement

Company Overview