Senior DME Operations & Revenue Integrity Specialist

Job Description

Job Description

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

Requirements

• 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