Medicare DMEPOS Medical Reviewer

Job Summary

A company is looking for a Medicare DMEPOS Medical Reviewer, Surgical Dressings (Contract).

Key Responsibilities

• Interpret and operationalize LCDs and policy articles for surgical dressings, establishing practical rules and criteria
• Implement pre-bill controls and build a quality assurance process for surgical dressing claims
• Lead audit and appeals processes, coaching the internal billing team and creating a reusable appeals library

Required Qualifications

• 3-5+ years of medical review experience at a UPIC or MAC
• Hands-on adjudication experience with various surgical dressings
• Expertise in proof of delivery standards and common denial rationales
• Strong writing skills with a focus on policy and compliance
• Preferred background in RN/WOCN or wound care, and experience with denial analysis tools