DME Intake - Patient, Insurance, and Documentation Specialist

Intake, Documentation, & Insurance Verification Specialist 

Department: Operations 

Reports To: Owner / Operations Manager 

Position Summary 

The Intake, Documentation & Insurance Verification Specialist is responsible for ensuring all patient orders are complete, compliant, and financially clear prior to fulfillment. This role owns the front-end accuracy of the patient lifecycle—intake, documentation, insurance verification, and resupply readiness—ensuring clean handoffs to billing and long-term patient success. This position is for a seasoned DME professional who understands payer rules, CMS documentation standards, and how strong intake directly impacts billing, compliance, and patient satisfaction. 

Patient Intake & Referral Management 

• Receive, review, and process incoming referrals from physicians and healthcare partners • Validate referrals for completeness, medical necessity, and payer requirements 

• Obtain and verify patient demographics, diagnoses, and insurance information 

• Communicate with referral sources to resolve missing or incorrect documentation 

Documentation & Compliance 

• Collect, review, and maintain physician orders, CMNs/LMNs, and supporting medical records • Ensure documentation meets CMS, Medicare, and payer-specific standards prior to fulfillment • Maintain organized, audit-ready patient records within NikoHealth 

• Follow SOPs and documentation checklists to prevent downstream billing issues 

• Proactively identify and resolve documentation gaps before escalation 

Insurance Verification & Patient Financial Responsibility 

• Verify Medicare and secondary insurance eligibility and benefits 

• Confirm coverage criteria, frequency limitations, and authorization requirements 

• Accurately determine patient out-of-pocket responsibility, including deductibles and coinsurance • Clearly and professionally explain coverage details and financial responsibility to patients • Document insurance verification and patient cost discussions in the system 

Resupply Coordination Support 

• Track resupply eligibility based on payer guidelines 

• Ensure updated documentation and continued medical necessity are on file for resupply • Coordinate with billing and RCM teams to support clean resupply claims 

• Maintain accurate resupply notes, follow-ups, and task tracking 

Team Collaboration & Cross-Functional Support

• Work closely with billing, RCM, and resupply teams to ensure end-to-end workflow accuracy • Provide cross-coverage support during high-volume periods 

• Act as a team player who understands how intake, verification, resupply, and billing impact one another 

30–60–90 Day Success Plan

First 30 Days: Systems & Accuracy 

• Learn Ease DME payer mix and end-to-end revenue workflows 

• Understand Medicare vs. Medicare Advantage vs. Commercial payer rules 

• Submit and track claims under supervision to understand downstream impacts • Review common denial and adjustment reasons tied to intake and documentation gaps • Achieve 90% claim accuracy on supported workflows 

Days 31–60: Ownership & Control 

• Independently manage assigned intake, documentation, and verification workflows • Support denial prevention by ensuring clean, compliant front-end documentation • Coordinate closely with billing on root causes tied to documentation or eligibility • Maintain accurate tracking and timely follow-up on outstanding items 

• Contribute to a 20% reduction in preventable denials through improved intake quality 

Days 61–90: Optimization & Scale 

• Fully own front-end revenue readiness for assigned payors 

• Identify payer behavior trends that impact documentation, eligibility, or coverage • Improve clean-claim and first-pass payment performance through intake accuracy • Support appeals and recoupment defense with audit-ready documentation 

• Maintain 95%+ clean-claim submission rate through strong intake controls 

What Success Looks Like 

• High first-pass documentation approval rates 

• Clear communication in addendum requests and shipment delays 

• Clean, audit-ready patient files 

• Consistent compliance with Medicare and payer guidelines 

Required Skills & Qualifications 

• 2–5 years of DME intake, documentation, or insurance verification experience 

• Strong knowledge of Medicare, CMS documentation standards, and payer guidelines

• Experience with NikoHealth or similar DME management systems 

• Ability to confidently explain insurance benefits and out-of-pocket costs to patients

• Highly detail-oriented and process-driven 

• Strong communication and organizational skills 

• HIPAA-compliant and professionalism-focused 

Preferred Experience 

• Experience with urological supplies and/or CGM (Continuous Glucose Monitoring)

• Prior exposure to documentation reviews, audits, or payer requests 

Why Join Us 

• Make an immediate and meaningful impact by helping ensure patients receive timely, compliant access to essential medical supplies

• Play a direct role in supporting not only the company’s success, but the health and well-being of the community we serve 

• Join a growing organization with clear opportunities for professional growth as the company continues to scale

• Be part of a collaborative, team-oriented work environment where your expertise and contributions are genuinely valued 

• Work closely with leadership in an organization that prioritizes compliance, quality, and employee support