Eligibility/Intake DME Processor

Job Description

Job Description

Company Overview

The Breastfeeding Shop is for mothers who need proper help, guidance, and accessories to help them with nursing their babies, The Breastfeeding Shop brings the best of all. We are a family-owned business and because we understand the joys and challenges of being a new mom, we have brought together a range of supplies for all mothers who choose to breastfeed or those who need access to a breast pump. We offer paid time off, and medical, dental, and vision at a shared cost.

Position Summary

We are seeking a full-time, detail-oriented and organized Eligibility/Intake DME Processor to join our on-stite team in Emmaus, PA.  The ideal candidate will play a crucial role in verifying and processing commercial insurance claims related to durable medical equipment, primarily breast pumps and accessories. The Eligibility/Intake DME Processor is responsible for reviewing new referrals, verifying patient insurance benefits, obtaining required documentation, and ensuring all Durable Medical Equipment (DME) orders meet payer and regulatory requirements prior to order processing and billing. This role serves as a critical liaison among patients, physicians, and insurance companies.  This position requires a strong understanding of major insurance companies’ verification processes. The successful applicant will be responsible for ensuring that all orders are submitted timely, accurately and efficiently, while adhering to durable medical equipment guidelines and HIPAA regulations.  Remote consideration may be given to well qualified candidates.  

Essential Duties and Responsibilities

Insurance Verification & Eligibility

• Verify patient insurance coverage, benefits, deductibles, co-insurance, and authorization requirements.
• Confirm eligibility through payer websites, portals, and direct payer communication.
• Determine coverage criteria based on payer-specific policies and guidelines.
• Document all verification and benefit information accurately within company systems.

Intake Processing

• Receive and review referrals, prescriptions, and support documentation.
• Validate physician orders for accuracy, completeness, and compliance.
• Review medical records to ensure documentation supports medical necessity.
• Identify missing information and obtain required documentation from providers and patients.

Authorization & Documentation Management

• Initiate and track prior authorization requests when required.
• Follow up with insurance companies and physician offices regarding pending approvals.
• Maintain complete and organized patient files.
• Ensure all documentation meets Medicare, Medicaid, commercial insurance, and accreditation requirements.
• Other duties as assigned.

Qualifications

Education

• High School Diploma or GED required.
• Associate's degree in healthcare administration, medical billing, or related field preferred.

Experience

• Minimum 1-2 years of DME, medical billing, intake, insurance verification, or healthcare customer service experience preferred.
• Experience with Medicare, Medicaid, and commercial insurance plans strongly preferred.
• Experience with prior insurance authorization processes and medical documentation requirements.

Knowledge and Skillset

• Strong understanding of insurance eligibility verification and benefits investigation.
• Knowledge of DMEPOS products and payer requirements.
• Proficiency with electronic medical records (EMR), Brightree, Niko Health, Sales Force, or similar healthcare software.
• Strong analytical and problem-solving skills.
• Excellent written and verbal communication abilities.
• Ability to manage multiple priorities and meet deadlines.
• Strong attention to detail and accuracy.

Physical Requirements

• Prolonged periods of sitting and computer work.

The Breastfeeding Shop is for mothers who need assistance and guidance, selecting their pumps and accessories to help them with nursing their babies. We are a family-focused business and because we understand the joys and challenges of being a new mom, we have brought together a range of supplies for all mothers who choose to breastfeed or those who need access to a breast pump.

The Breastfeeding Shop is an equal-opportunity employer.