[Remote] Medical Reviewer, Surgical Dressings

Responsibilities Interpret and operationalize LCD L33831 and policy articles for surgical dressings Translate LCDs and policy articles into practical checklists and guidelines Develop and implement pre-bill controls to ensure clinical completeness and billing correctness Lead UPIC/MAC ADR responses (pre- and post-pay) Coach internal billing team on specific documentation requirements Develop and track metrics related to initial denial rates, appeal win rates, ADR turnaround times, and other key performance indicators Train customer-facing team members and billers on specific documentation requirements Enablement & Analytics: Define and track metrics, and develop reusable appeals library with policy citations and exemplars Policy → Practice: Interpret and operationalize LCDs and policy articles, and publish practical rules and guidelines Pre-Bill Controls: Build and pilot a 2-gate QA process for surgical-dressing claims Requirements 3-5+ years medical-review experience Ability to interpret and operationalize LCDs and policy articles Experience with CMS regulations and policies as applied by MACs and UPICs Strong analytical and problem-solving skills Ability to translate complex information into practical checklists and guidelines Excellent communication and training skills Experience with pre-bill controls and audit/appeals processes Ability to work independently and as part of a team Strong attention to detail and ability to prioritize tasks Familiarity with medical terminology and coding systems (e.g. ICD-10, CPT) Apply Now Apply Now