DME & PAP Eligibility Specialist

AdaptHealth; United States; On-site; USD 55,000 - 75,000; Full time

Job summary

AdaptHealth is seeking a Qualification Specialist to evaluate patient eligibility and medical necessity for DME, PAP devices, and oxygen therapy, ensuring Medicare/Medicaid compliance and timely access to equipment.

Responsibilities include reviewing clinical documentation, verifying insurance benefits and prior authorizations, coordinating with physicians and therapists, handling appeals, and supporting audits while upholding HIPAA and quality standards.

Qualifications

• Knowledge of Medicare/Medicaid guidelines and coverage criteria.
• Experience with DME/respiratory equipment coverage and medical necessity.
• Ability to review clinical documentation and determine eligibility.

Responsibilities

• Evaluate patient eligibility for DME, PAP, and oxygen equipment.
• Verify insurance benefits and prior authorizations; submit requests.
• Coordinate with physicians and therapists to obtain required information.
• Prepare and submit appeals for denials with supporting evidence.
• Monitor authorizations and assist with reauthorizations as needed.
• Support audits by providing qualification records and reports.

Skills

Medicare/Medicaid guidelines

Regulatory knowledge

Analytical skills

Communication skills

HIPAA/compliance

Technical proficiency

Education

Associate’s degree in healthcare administration

High school diploma or equivalent

Tools

Electronic Health Records (EHR)

Microsoft Office Suite

Insurance portals

Job description

AdaptHealth is seeking a Qualification Specialist to evaluate patient eligibility and medical necessity for DME, PAP devices, and oxygen therapy, ensuring Medicare/Medicaid compliance and timely access to equipment.

Responsibilities include reviewing clinical documentation, verifying insurance benefits and prior authorizations, coordinating with physicians and therapists, handling appeals, and supporting audits while upholding HIPAA and quality standards.