Medical Reviewer – Durable Medical Equipment Specialist

🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔍🏥 Medical Reviewer

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• Review DME-related claims, Treatment Authorization Requests (TARs), prescriptions, and supporting medical documentation • Evaluate durable medical equipment requests against medical policies, coverage requirements, and program guidelines • Review documentation supporting medical necessity and appropriate DME use • Apply knowledge of DME products, supplies, billing practices, and healthcare reimbursement • 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 Medical Review Services professionals • Maintain knowledge of DME policies, coverage requirements, billing practices, and regulatory guidelines • Meet established quality, accuracy, productivity, and turnaround-time expectations

🎯 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 • Management of a DME business and/or understanding of healthcare billing preferred • 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 • Must work from a home office while supporting California healthcare programs • Ability to navigate multiple computer systems and applications

🏖️ Benefits

• Flexible hours • Work-life balance • Continuous learning and career development • Generous, flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies • Ongoing training and support related to program requirements, systems, policies, and medical review processes