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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
Requirements
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
Benefits
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