DME Authorization & Financial Clearance Specialist

Description

DME Authorization & Financial Clearance Specialist is responsible for securing timely insurance authorizations for Durable Medical Equipment (DME) while ensuring patients are financially cleared prior to service. This role plays a critical part in preventing denials, ensuring compliance with payer requirements, and providing patients with transparent cost expectations. The ideal candidate has strong payer knowledge, attention to detail, and excellent patient communication skills.



Experience with eClinical

Works (eCW) is a plus.

• Obtain prior authorizations for DME (e.g., braces, orthotics, stim devices, supplies) across commercial, Medicare, Medicaid, and Workers’ Compensation payers
• Verify medical necessity, diagnosis-to-device alignment, and supporting clinical documentation within the EHR (
  eClinical
  
  Works experience preferred
  )
• Submit authorization requests via payer portals, fax, phone, or clearinghouse tools
• Track authorization status and follow up proactively to avoid treatment delays
• Document authorization numbers, validity dates, and payer-specific limitations accurately in eCW or designated PM system
• Escalate denials or delays and support reconsiderations or appeals as needed

• Verify eligibility and DME benefits prior to dispensing
• Calculate patient financial responsibility including deductibles, co‑insurance, and non‑covered items
• Provide clear cost estimates and explain financial responsibility to patients in a professional, empathetic manner
• Collect patient payments or secure signed financial responsibility acknowledgments when required
• Identify self‑pay scenarios and coordinate payment plans per company policy
• Ensure all financial clearance requirements are completed and documented prior to DME release

• Ensure adherence to payer-specific DME rules, LCD/NCD guidelines, and documentation standards
• Maintain accurate and complete records within eClinical Works and payer systems
• Collaborate with providers, clinical staff, billing, and AR teams to ensure clean claim submission
• Maintain HIPAA compliance and protect patient financial and clinical information
• Identify authorization trends, denial drivers, and workflow opportunities for improvement

• Medical, Dental, Vision Insurance
• 401k with 4% match
• Paid Time Off
• Short & Long‑Term Disability
• HSA with $720 annual match
• FSA + Dependent Care FSA
• Life Insurance (company paid + voluntary options)
• 9.5 Paid Holidays for the Year 2026
• Employee Assistance Programs
• Voluntary Hospital, Critical Illness & Accident Coverage

• High School Diploma or GED (Associate’s degree preferred)
• 2+ years of experience in DME authorization, insurance verification, and financial clearance
• Strong working knowledge of payer authorization requirements and benefit structures
• Experience working with Medicare and commercial payers
• Proficiency with payer portals and authorization workflows
• Excellent organizational, documentation, and communication skills

• Hands‑on experience with eClinical
  
  Works (eCW)
• Experience in pain management, orthopedics, or surgical specialties
• Knowledge of Workers’ Compensation DME authorization processes
• Familiarity with DMEPOS and Medicare compliance requirements
• Point‑of‑service collection experience

• Attention to detail and accuracy
• Strong patient communication skills
• Time management and prioritization
• Problem‑solving and payer navigation
• Ability to work independently and collaboratively

• Authorization turnaround time
• DME denial rate
• Percentage of DME financially cleared prior to dispensing
• Accuracy of eCW documentation
• Audit and compliance adherence