Medical Reviewer (Prosthetic and Orthotic Devices Specialist)
G
Gainwell TechnologiesMedical review
Source API remote eligibility restrictions: United StatesFull-TimeSenior
Salary70,000 - 90,000 USD per year
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Job Details
- Experience
- Ownership or management of a Prosthetic and Orthotic business within the past five (5) years preferred.
- Required Skills
- Analytical SkillsWritten communicationVerbal communication
Requirements
- Have professional experience as a Prosthetic and Orthotic (P&O) practitioner consistent with program requirements.
- Hold certification in Prosthetics and Orthotics.
- Have strong knowledge of prosthetic and orthotic devices, services, and clinical applications.
- Be able to interpret medical documentation, prescriptions, and supporting device information.
- Have strong analytical, written, and verbal communication skills.
- Be able to work independently and collaborate effectively with clinical, operational, and cross-functional teams.
- Ownership or management of a Prosthetic and Orthotic business within the past five years is preferred.
- Maintain professional certifications and credentials required for the position in active and good-standing status, as applicable.
Responsibilities
- Review claims, Treatment Authorization Requests (TARs), prescriptions, and supporting documentation involving prosthetic and orthotic devices.
- Evaluate prosthetic and orthotic requests against applicable coverage requirements, medical policies, and professional standards.
- Assess documentation supporting the medical need and appropriate use of prosthetic and orthotic devices.
- Provide subject-matter expertise on prosthetic and orthotic equipment, services, and practices.
- Support claim adjudication and authorization activities involving prosthetic and orthotic services.
- Document review findings, decisions, and supporting rationale accurately and on time.
- Identify documentation or coverage issues requiring additional review or clarification.
- Collaborate with clinicians, providers, operations teams, and other Medical Review Services specialists.
- Maintain knowledge of applicable standards, coverage requirements, policies, and regulatory guidelines.
- Meet established quality, accuracy, productivity, and turnaround-time expectations.
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