Senior DME Operations & Revenue Integrity Specialist

About Ease DME Ease DME is a compliance-forward Durable Medical Equipment provider specializing in urology supplies. We are building a highly controlled, audit-ready Medicare DME operation and are seeking our first senior operations hire. This role protects compliance, cash flow, and accreditation integrity. Position Summary The Senior DME Operations & Revenue Integrity Specialist owns front-end documentation compliance, insurance verification, and revenue readiness for Medicare and commercial claims. This individual ensures what ships is billable and what bills is defensible. This is not a clerical intake role. This is a high-accountability Medicare DME position. Core Responsibilities Documentation & Compliance Review physician orders and supporting medical records Validate medical necessity for straight, coude, and closed system catheters Ensure frequency limits and diagnosis alignment meet Medicare standards Maintain audit-ready patient files in NikoHealth Escalate documentation risks before shipment Insurance & Revenue Readiness Verify Medicare, MA, and commercial eligibility Confirm frequency limitations and coverage requirements Ensure claims are documentation-complete prior to submission Denial Prevention & Revenue Oversight Analyze denial root causes Improve clean-claim rate Support appeals and recoupments Monitor AR trends and timely filing limits Process Development Strengthen Order workflows Build documentation checklists Contribute to scalable team structure as volume grows 30-60-90 Day Plan First 30 Days – Foundation & Familiarization Goal: Build a strong understanding of Ease DME’s billing systems, payer requirements, and compliance standards. Milestones: Complete onboarding and training on NikoHealth, payer portals, and internal workflows. Review 20+ recent claims and denials to identify common issues. Learn Medicare and commercial payer rules for urology supplies (catheters, frequency limits, modifiers). Shadow senior billing staff to understand claim submission and follow-up cadence. Achieve 90% accuracy on supervised claim submissions. Days 31–60 – Ownership & Efficiency Goal: Take ownership of assigned billing queues and begin improving clean-claim rates. Milestones: Independently manage daily claim submissions and follow-ups. Reduce preventable denials by 15–20% through proactive documentation checks. Demonstrate consistent use of NikoHealth notes and task tracking. Identify recurring documentation or intake issues and communicate with the intake team. Maintain ≥93% clean-claim submission rate. Days 61–90 – Optimization & Leadership Goal: Drive measurable improvements in revenue cycle performance and compliance. Milestones: Fully own billing and AR management for assigned payers. Maintain ≥95% clean-claim submission rate and reduce aging >60 days by measurable percentage. Lead at least one process improvement initiative (e.g., denial prevention workflow). Support audit readiness by ensuring documentation completeness. Mentor intake staff on documentation best practices impacting billing. Why This Role Matters This hire directly protects: Medicare billing privileges ACHC accreditation Revenue integrity Audit exposure We are seeking someone who thinks: “Would this survive a Medicare audit?” Compensation Competitive base salary with performance bonuses tied to: Clean-claim rate Preventable denial reduction Documentation audit score 3+ years Medicare Part B DME billing experience Urology supply (catheter) billing or documentation experience Hands-on denial correction and appeals experience Experience using NikoHealth or similar DME system Strong written and verbal English communication Ability to think critically under compliance pressure Preferred: Diabetes / CGM billing experience ACHC or audit exposure Prior workflow or team-building experience #J-18808-Ljbffr