Medical Reviewer – Speech and Audiology Specialist

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

📋 Description

• Assess speech, language, and audiology-related claims, Treatment Authorization Requests (TARs), treatment plans, and clinical documentation.

• Analyze requested services in accordance with relevant medical policies, coverage criteria, and professional standards.

• Utilize expertise in speech-language pathology or audiology to assist in determining medical necessity and appropriateness.

• Examine treatment plans and accompanying documentation for both requested and billed services.

• Accurately and promptly document review findings, decisions, and the supporting clinical rationale.

• Refer cases that necessitate further clinical review to the appropriate medical professionals as needed.

• Work in partnership with physicians, nurses, other clinical specialists, operations teams, and business partners to address review inquiries.

• Stay informed on relevant professional standards, medical policies, coverage criteria, and regulatory guidelines.

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

• Navigate various computer systems and applications to complete reviews, document findings, and facilitate timely determinations.

• Provide support to Medical Review Services for California healthcare programs.

⛳️ Requirements

• A minimum of three (3) years of experience as a Speech, Language, or Audiology practitioner.

• Valid California professional credentials applicable to the discipline.

• A current Certificate of Clinical Competence in Speech-Language Pathology or Audiology issued by the American Speech-Language-Hearing Association, in line with applicable program requirements.

• Excellent oral and written communication abilities.

• Strong clinical judgment with the capacity to interpret clinical records, treatment plans, and associated documentation.

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

• Maintain all necessary professional licenses, certifications, and credentials in active and good-standing status as required for the position.

🏝️ Benefits

• Flexible hours.

• Work-life balance.

• Continuous learning and career development opportunities.

• 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.