Medical Reviewer – Durable Medical Equipment Specialist

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

📋 Description

• Assess claims related to Durable Medical Equipment (DME), Treatment Authorization Requests (TARs), prescriptions, and accompanying medical records.

• Analyze DME requests in accordance with medical policies, coverage criteria, and program standards.

• Review documentation that supports the medical necessity and appropriate use of DME.

• Utilize knowledge of DME products, supplies, billing practices, and healthcare reimbursement processes.

• Assist in the adjudication of claims and authorization activities pertaining to DME.

• Accurately and promptly document findings, decisions, and the rationale behind them.

• Identify issues related to documentation, billing, or coverage that require further investigation or clarification.

• Collaborate with clinicians, providers, operations teams, and professionals from Medical Review Services.

• Stay informed about DME policies, coverage criteria, billing practices, and regulatory standards.

• Achieve established goals for quality, accuracy, productivity, and turnaround time.

⛳️ Requirements

• At least three (3) years of professional experience in the field of Durable Medical Equipment (DME).

• Solid understanding of DME products, equipment, supplies, and their applications.

• Experience managing a DME business and/or a background in healthcare billing is preferred.

• Capability to interpret medical documentation, prescriptions, claims, and related information.

• Excellent analytical, documentation, written, and verbal communication abilities.

• Ability to work autonomously while effectively collaborating with clinical, operational, and cross-functional teams.

• Must operate from a home office while supporting California healthcare initiatives.

• Proficient in navigating various computer systems and applications.

🏝️ Benefits

• Flexible hours

• Work-life balance

• Continuous learning and career development

• Generous, flexible vacation policy

• 401(k) employer match

• Comprehensive health benefits

• Educational assistance

• Leadership and technical development academies

• Ongoing training and support related to program requirements, systems, policies, and medical review processes