Qualification Specialist

Job Summary

Evaluating patient eligibility for Durable Medical Equipment (DME) and oxygen therapy services, the fully remote Qualification Specialist will ensure compliance with insurance requirements and regulatory standards while facilitating timely access to necessary equipment for patients.

Key responsibilities

• Evaluate patient medical records and clinical documentation to determine eligibility and medical necessity for DME and oxygen therapy
• Verify insurance benefits and submit authorization requests, ensuring timely patient access to prescribed medical equipment
• Collaborate with healthcare providers to gather necessary documentation and provide guidance on coverage criteria

Required qualifications

• High school diploma or equivalent required; associate's degree in healthcare administration or related field preferred
• Previous experience in healthcare, insurance, or patient services preferred
• Knowledge of Medicare/Medicaid guidelines and DME services preferred
• One year of relevant work experience required for entry-level; additional experience required for senior and lead levels
• Proficiency with patient management systems and healthcare software applications