Position Summary:

The Qualification Specialist is responsible for evaluating patient eligibility and medical necessity for Durable Medical Equipment (DME), Positive Airway Pressure (PAP) devices, and oxygen therapy services. This role ensures compliance with insurance requirements, regulatory standards, and clinical guidelines while facilitating timely access to medically necessary equipment for patients.

The lead specialist serves as a subject matter expert, conducts new hire training and mentor to the team.

Essential Functions and Job Responsibilities:

• Patient Eligibility Assessment: Evaluate patient medical records, physician orders, and clinical documentation to determine eligibility for DME, PAP, and oxygen therapy equipment. Review diagnostic test results, medical history, and treatment plans to assess medical necessity in accordance with Medicare, Medicaid, and commercial insurance guidelines....