Pain Specialists of America · 3 weeks ago
DME Authorization & Financial Clearance Specialist
Georgetown,TX,US
Full-time
Onsite
Entry, Mid Level
2+ years expPain Specialists of America is seeking a DME Authorization & Financial Clearance Specialist responsible for securing timely insurance authorizations for Durable Medical Equipment (DME) and ensuring patients are financially cleared prior to service. The role involves obtaining prior authorizations, verifying eligibility and benefits, and ensuring compliance with payer requirements.
Health CareHealth DiagnosticsMedical
Responsibilities
Obtain prior authorizations for DME (e.g., braces, orthotics, stim devices, supplies) across commercial, Medicare, Medicaid, and Workers’ Compensation payers
Verify medical necessity, diagnosis-to-device alignment, and supporting clinical documentation within the EHR (eClinicalWorks experience preferred)
Submit authorization requests via payer portals, fax, phone, or clearinghouse tools
Track authorization status and follow up proactively to avoid treatment delays
Document authorization numbers, validity dates, and payer-specific limitations accurately in eCW or designated PM system
Escalate denials or delays and support reconsiderations or appeals as needed
Verify eligibility and DME benefits prior to dispensing
Calculate patient financial responsibility including deductibles, co-insurance, and non-covered items
Provide clear cost estimates and explain financial responsibility to patients in a professional, empathetic manner
Collect patient payments or secure signed financial responsibility acknowledgments when required
Identify self-pay scenarios and coordinate payment plans per company policy
Ensure all financial clearance requirements are completed and documented prior to DME release
Ensure adherence to payer-specific DME rules, LCD/NCD guidelines, and documentation standards
Maintain accurate and complete records within eClinicalWorks and payer systems
Collaborate with providers, clinical staff, billing, and AR teams to ensure clean claim submission
Maintain HIPAA compliance and protect patient financial and clinical information
Identify authorization trends, denial drivers, and workflow opportunities for improvement
Qualification
Required
High School Diploma or GED (Associate's degree preferred)
2+ years of experience in DME authorization, insurance verification, and financial clearance
Strong working knowledge of payer authorization requirements and benefit structures
Experience working with Medicare and commercial payers
Proficiency with payer portals and authorization workflows
Excellent organizational, documentation, and communication skills
Preferred
Hands-on experience with eClinicalWorks (eCW)
Experience in pain management, orthopedics, or surgical specialties
Knowledge of Workers' Compensation DME authorization processes
Familiarity with DMEPOS and Medicare compliance requirements
Point-of-service collection experience
Benefits
Medical, Dental, Vision Insurance
401k with 4% match
Paid Time Off
Short & Long-Term Disability
HSA with $720 annual match
FSA + Dependent Care FSA
Life Insurance (company paid + voluntary options)
9.5 Paid Holidays for the Year 2026
Employee Assistance Programs
Voluntary Hospital, Critical Illness & Accident Coverage
Company
Pain Specialists of America
Pain Specialists of America is an interventional pain management practice that offers intradiscal treatment and whiplash treatment services.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Douglas Badertscher
Chief Executive Officer, Director
Company data provided by crunchbase