DME Prior Authorization Specialist

Job description:

DME Prior Authorization Specialist

Company: Pride Medical Equipment LLC
Job Type: Full-Time / Part-Time
Pay: $19.00–$23.00 per hour
Industry: Durable Medical Equipment (DME) / Healthcare

About the Company

Pride Medical Equipment LLC is a growing healthcare organization specializing in respiratory care, diabetes management, and mobility solutions. We are committed to providing quality patient care through efficient service, accurate documentation, and compliance with insurance and medical necessity requirements.

Position Overview

Pride Medical Equipment is seeking an experienced, detail-oriented, and organized DME Prior Authorization Specialist to manage insurance authorization requests and ensure that all required clinical documentation is complete before equipment is dispensed.

The ideal candidate will have experience with DME prior authorizations, insurance verification, or healthcare revenue cycle operations. This individual should understand payer requirements, medical necessity criteria, and documentation standards, while maintaining accuracy and efficiency in a fast-paced environment.

Key Responsibilities

• Review incoming DME orders for accuracy, completeness, and medical necessity.
• Determine prior authorization requirements based on payer guidelines and the equipment ordered.
• Submit and manage prior authorization requests for Medicare, Medicare Advantage, Medicaid, and commercial insurance plans.
• Verify insurance eligibility, benefits, coverage limitations, and authorization requirements.
• Review physician orders, progress notes, sleep studies, and supporting clinical documentation to ensure compliance with payer-specific criteria.
• Request missing or additional documentation from referring physician offices.
• Follow up with insurance companies on pending authorizations and work to prevent unnecessary delays.
• Identify and help resolve authorization denials, documentation deficiencies, and requests for additional information.
• Track authorization statuses, effective dates, expiration dates, and approved units.
• Coordinate with intake, scheduling, billing, and clinical teams to support timely patient care.
• Maintain accurate records of authorization activities in the electronic medical record (EMR) system.
• Stay informed about changes in Medicare, Medicaid, and commercial insurance policies.
• Process assigned orders accurately and within established productivity timelines.

Qualifications and Requirements

• At least 2 years of experience in DME prior authorizations, insurance verification, or related healthcare revenue cycle operations is preferred.
• Prior experience in the Durable Medical Equipment (DME) industry is strongly preferred.
• Knowledge of Medicare, Medicaid, Medicare Advantage, and commercial insurance guidelines.
• Familiarity with DME HCPCS codes, ICD-10 diagnosis codes, and medical necessity requirements.
• Experience submitting authorization requests through insurance portals and communicating with insurance representatives.
• Ability to review clinical documentation and identify missing information required for authorization approval.
• Strong organizational skills and the ability to manage multiple requests simultaneously.
• Excellent written and verbal communication skills.
• High attention to detail, accuracy, and follow-through.
• Ability to work independently, prioritize tasks, and take ownership of assigned authorizations.
• Proficiency with electronic medical records and Microsoft Office or Google Workspace.

Preferred: Experience with Brightree is a significant advantage.

Preferred DME Equipment Experience

Experience with prior authorizations for any of the following equipment categories is highly desirable:

• CPAP/APAP and BiPAP devices
• Non-Invasive Ventilators (NIV)
• Continuous Glucose Monitors (CGM)
• Airway clearance devices, including AffloVest
• Power wheelchairs, scooters, and other mobility equipment
• Hospital beds and related durable medical equipment

Preferred Insurance Experience

Experience working with Illinois Medicaid Managed Care Organizations and commercial insurance providers, including the following, is highly desirable:

• Blue Cross Blue Shield (BCBS)
• Aetna
• UnitedHealthcare
• Humana
• Molina
• Meridian
• CountyCare

What We're Looking For

Accountability: Takes ownership of assigned authorizations from submission through final determination.

Efficiency: Manages a high volume of orders while maintaining accuracy.

Attention to Detail: Identifies missing documentation and potential issues before submission to reduce delays and denials.

Problem-Solving: Proactively follows up on pending requests and works to resolve authorization obstacles.

Communication: Communicates professionally and promptly with insurance companies, referring providers, and internal teams.

Teamwork: Collaborates effectively with colleagues to support efficient workflows and quality patient care.

Why Join Pride Medical Equipment?

Join a growing healthcare organization where accuracy, accountability, teamwork, and patient service are valued. Pride Medical Equipment offers a professional, team-oriented environment where employees can contribute to operational efficiency, develop their expertise, and support the delivery of essential medical equipment to patients.

Equal Opportunity Employer

Pride Medical Equipment LLC is an Equal Opportunity Employer. All qualified applicants are encouraged to apply.

Job Types: Part-time, Full-time

Benefits:

• Health insurance
• Paid time off

Experience:

• DME billing: 2 years (Required)
• Brightree system: 1 year (Required)

Work Location: In person

At Pride Medical Equipment, we help patients access the equipment and support they need to live healthier, more independent lives. We’re looking for compassionate, dependable, and motivated individuals who take ownership of their work and care about the people they serve.

Join a supportive team that values collaboration, accountability, and continuous learning. As Pride grows, you’ll have opportunities to develop your skills, take on new responsibilities, and make a meaningful impact on patients and their families.