Clinical Compliance Reviewer

🕒 5 days ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔍🏥 Medical Reviewer

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Tobii Dynavox

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2001

⚕️ Healthcare Insurance

👥 HR Tech

🧘 Wellness

Healthcare Insurance • HR Tech • Wellness

Tobii Dynavox is a company dedicated to developing and providing assistive technology solutions for people with communication disabilities. They offer a range of products including augmentative and alternative communication (AAC) devices, eye-tracking technology, and communication apps. Tobii Dynavox aims to enhance the lives of individuals with conditions such as ALS, autism, and cerebral palsy by enabling effective communication through speech-generating devices and cutting-edge technology. The company also provides training, support, and a variety of accessories to support their extensive product line, focusing on personalizing solutions to meet individual needs. Tobii Dynavox products are used globally by individuals, professionals, and organizations.

📋 Description

• Ensure clinical documentation meets payer-specific insurance coverage criteria • Perform comprehensive reviews of SLP evaluation reports and related clinical documentation • Evaluate documentation for completeness, accuracy, and medical necessity • Support the funding workflow by ensuring clinical documentation is audit-ready • Collaborate with funding teams to resolve clinical documentation issues • Provide clear, actionable feedback to SLPs to improve report quality • Assist in maintaining and updating payer-specific clinical criteria checklists

🎯 Requirements

• Bachelor’s Degree and/or 3-5 years healthcare/clinical-related experience • Background in clinical or clinical-related field • Knowledge of DME Billing and Prior Authorizations • Technical writing skills • Intermediate level skills in Microsoft Word & Excel with ability to learn additional systems as needed • Communication skills (written, oral and interpersonal) • Able to work independently and within a team environment • Interpersonal skills to build relationships with recommenders • Familiarity of the healthcare field • Knowledge of Medicare, Medicaid, Commercial Insurance • Time Management • Decision-making and problem-solving skills • Proper grammar skills • Phone etiquette skills • Ability to work with interruptions • Flexibility to adapt to new projects

🏖️ Benefits

• Flexible to do what truly matters to you outside of work • Work culture where collaboration is the norm and individuality is welcomed. • Opportunities for career growth within a dynamic global company.