Clinical Compliance Reviewer

This is a fully remote position, open to applicants in Pennsylvania.

📋 Description

• Ensure that clinical documentation complies with payer-specific insurance coverage requirements.

• Conduct thorough reviews of SLP evaluation reports along with related clinical documentation.

• Assess documentation for completeness, accuracy, and medical necessity.

• Facilitate the funding workflow by ensuring that clinical documentation is ready for audits.

• Work collaboratively with funding teams to address any issues related to clinical documentation.

• Offer clear, actionable feedback to SLPs to enhance the quality of reports.

• Assist in the maintenance and updating of payer-specific clinical criteria checklists.

⛳️ Requirements

• Bachelor’s Degree and/or 3-5 years of experience in healthcare or a clinical-related field.

• Experience in a clinical or clinically related field.

• Familiarity with DME Billing and Prior Authorizations.

• Skills in technical writing.

• Intermediate proficiency in Microsoft Word and Excel, with the ability to learn new systems as required.

• Strong communication skills, both written and verbal, as well as interpersonal skills.

• Capacity to work independently as well as part of a team.

• Strong interpersonal skills to develop relationships with recommenders.

• Understanding of the healthcare industry.

• Knowledge of Medicare, Medicaid, and Commercial Insurance.

• Effective time management abilities.

• Skills in decision-making and problem-solving.

• Proficiency in grammar.

• Skills in phone etiquette.

• Ability to work amidst interruptions.

• Flexibility to adapt to new projects.

🏝️ Benefits

• Flexibility to engage in what truly matters to you outside of work.

• A workplace culture where collaboration is encouraged and individuality is embraced.

• Opportunities for career advancement within a vibrant global organization.