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Intake, Documentation, & Insurance Verification Specialist 

Department: Operations 

Reports To: Owner / Operations Manager 

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 

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 

Requirements

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 

Benefits

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