What are the responsibilities and job description for the DME Intake - Patient, Insurance, and Documentation Specialist position at Valgorithm?
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
First 30 Days: Systems & Accuracy
Required Skills & Qualifications
Why Join Us
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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
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
- Experience with urological supplies and/or CGM (Continuous Glucose Monitoring)
- Prior exposure to documentation reviews, audits, or payer requests
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