Medical Reviewer – Prosthetic and Orthotic Devices Specialist

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

📋 Description

• Examine claims, Treatment Authorization Requests (TARs), prescriptions, and relevant documentation related to prosthetic and orthotic devices.

• Analyze prosthetic and orthotic requests according to applicable coverage standards, medical policies, and professional guidelines.

• Evaluate documentation that supports the medical necessity and suitable usage of prosthetic and orthotic devices.

• Offer expertise concerning prosthetic and orthotic equipment, services, and methodologies.

• Assist in the adjudication of claims and authorization processes for prosthetic and orthotic services.

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

• Identify documentation or coverage concerns that necessitate further review or clarification.

• Collaborate with clinicians, providers, operations teams, and other specialists in Medical Review Services.

• Stay informed about relevant prosthetic and orthotic standards, coverage requirements, policies, and regulatory guidelines.

• Achieve established quality, accuracy, productivity, and turnaround time benchmarks.

• Navigate various computer systems and applications to conduct reviews, document findings, and facilitate timely decisions.

⛳️ Requirements

• Professional experience as a Prosthetic and Orthotic (P&O) practitioner in line with program criteria.

• Certification in Prosthetics and Orthotics is required.

• Previous ownership or management of a Prosthetic and Orthotic business within the last five (5) years is preferred.

• Comprehensive knowledge of prosthetic and orthotic devices, services, and their clinical applications.

• Competence in interpreting medical documentation, prescriptions, and supporting device details.

• Strong analytical, written, and verbal communication abilities.

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

• Maintain all required professional certifications and credentials in an active and good-standing status, as applicable.

🏝️ Benefits

• Flexible hours.

• Work-life balance.

• Continuous learning and career development opportunities.

• Generous and flexible vacation policy.

• 401(k) employer match.

• Comprehensive health benefits.

• Educational assistance.

• Leadership and technical development academies.

• Ongoing training and support.

• Remote work environment.