Qualification Specialist

Job Summary

Evaluating patient eligibility for Durable Medical Equipment, the remote Qualification Specialist will manage insurance verification, clinical documentation review, and regulatory compliance while ensuring timely access to necessary medical equipment.

Key responsibilities

• Assess patient medical records and clinical documentation to determine eligibility for DME, PAP, and oxygen therapy equipment
• Verify insurance benefits and submit authorization requests, ensuring compliance with Medicare and commercial insurance guidelines
• Collaborate with healthcare providers to gather 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 respiratory therapy or DME services preferred
• One year of work-related experience required; additional experience for senior and lead levels
• Familiarity with Medicare/Medicaid guidelines and regulatory compliance standards