Qualification Specialist

Job Summary

A company is looking for a Qualification Specialist responsible for evaluating patient eligibility and medical necessity for medical equipment and services.

Key Responsibilities

• Evaluate patient medical records and clinical documentation to determine eligibility for medical equipment
• Verify patient insurance benefits and submit authorization requests to ensure timely access to equipment
• Collaborate with healthcare providers to gather necessary documentation and provide guidance on coverage criteria

Required Qualifications, Training, and Education

• High school diploma or equivalent required; associate's degree preferred
• Previous experience in healthcare, insurance, medical billing, or patient services preferred
• Knowledge of respiratory therapy or DME services preferred
• One year of work-related experience required for entry-level; additional experience required for senior and lead levels
• Understanding of Medicare/Medicaid guidelines and healthcare compliance standards