Medical Reviewer

Job not on LinkedIn

3 days ago

Apply Now

Receive Emails with Similar Jobs

Limitlessli

WebsiteLinkedInAll Job Openings

Healthcare Insurance • Recruitment • SaaS

Limitlessli is a company that specializes in providing offsite staffing solutions for healthcare facilities. They offer customized staffing services for clinical and non-clinical roles, aiming to reduce operational costs and enhance efficiency. With a focus on remote staffing, Limitlessli supports healthcare operations by ensuring compliance with CMS, DOH, and other regulatory agencies through their Active Review Protocols (ARPs™). They provide MDS consulting services and cater to a wide array of healthcare settings including skilled nursing facilities, home healthcare, urgent care centers, and telehealth, among others. Their solutions are designed to increase ROI, offer scalable staffing options, and minimize stress for their clients.

51 - 200 employees

⚕️ Healthcare Insurance

🎯 Recruiter

☁️ SaaS

📋 Description

• Responsible for records progress for wound care intake • Pull reports and documents for patients who are at home with wounds at time of review • Communicate with the Payer team to determine which patients have insurance eligibility • Assess which wounds are eligible for supplies under Medicare medical necessity guidelines • Store and effectively organize records of clinical details, dispensing orders, and documents • Enter patient, wound, and dressing data into wound orders and onto spreadsheets • Add product specifics to spreadsheets, support product verification steps to prepare orders including sizes, quantities, preferred brands • Validate medical necessity for existing orders, document changes accurately • Communicate via email and phone with staff at homes, clarifications on clinical questions or timeline on order signatures required for delivery date • Collaborate with the clinical review team in other service lines may be required • Tracking communication and findings within the company system • Provide support for tracking systems, IT, and spreadsheet tools for chart reviews and order preparation • Support streamlining communication and workflow with resources available • Maintain working knowledge and tracking of product billing and reimbursement data • Product research, cost-effective and comparable product resources

🎯 Requirements

• 2+ years of clinical wound care experience preferred • Diploma/ Degree in Nursing, Medicine or related field • Excellent English communication skills, both verbal and written • Ability to work in a fast-paced environment • Strong critical thinking and customer service skills • Knowledge of eligibility, Medicare and product guidelines for education sessions i.e., Noridian LCD.

🏖️ Benefits

• Flexible working from home