Medical Reviewer (Durable Medical Equipment Specialist)
New
G
Gainwell TechnologiesHealthcare Administration
United StatesFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- Minimum of three (3) years of professional experience working with Durable Medical Equipment (DME).
Requirements
- Minimum of three (3) years of professional experience working with Durable Medical Equipment (DME).
- Strong knowledge of DME products, equipment, supplies, and their uses.
- Ability to interpret medical documentation, prescriptions, claims, and supporting information.
- Strong analytical, documentation, written, and verbal communication skills.
- Ability to work independently while collaborating effectively with clinical, operational, and cross-functional teams.
- Experience in DME business management or healthcare billing is preferred.
Responsibilities
- Review DME-related claims, Treatment Authorization Requests (TARs), prescriptions, and supporting medical documentation.
- Evaluate requests for durable medical equipment based on applicable medical policies, coverage requirements, and program guidelines.
- Review documentation supporting the medical necessity and appropriate use of durable medical equipment.
- Apply knowledge of DME products, supplies, billing practices, and healthcare reimbursement when completing reviews.
- Support claim adjudication and authorization activities involving DME.
- Document review findings, decisions, and supporting rationale accurately and timely.
- Identify documentation, billing, or coverage issues requiring additional review or clarification.
- Collaborate with clinicians, providers, operations teams, and other Medical Review Services professionals.
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