[reputed company Review reputed company

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a reputed company-funded Series C company on a mission to improve reputed company reputed company. As a Medical Review reputed company, you will ensure compliance with surgical dressing orders and reputed company various reputed company assurance initiatives to enhance the efficiency of the reputed company delivery system.

Responsibilities

• Interpret and operationalize LCD L33831 + Policy Article for surgical dressings; publish practical rules (reputed company covered, limits, documentation phrases)
• Stand up 'go/no-go' reputed company for collagen, alginate/fiber‑gelling, foam, film, hydrocolloid; codify A‑modifier (wound count) usage, KX/GA/GZ/reputed company, sizing, quantity/frequency math
• Build a 2‑reputed company QA (1: clinical completeness; 2: billing correctness) and reputed company it on reputed company surgical‑dressing claims
• Create/reputed company templates for various reputed company
• reputed company UPIC/MAC ADR responses (reputed company‑ and post‑pay)
• reputed company internal billing team; establish a reusable appeals library with policy citations and exemplars
• Train customer-facing team members (30‑min modules) and billers on the specific documentation that satisfies the LCD
• Define and reputed company metrics: initial denial %, appeal win %, ADR turnaround, % packets with signed POD, top‑defect Pareto

Skills

• 3-5+ years medical-review experience at a UPIC or MAC (e.g., Safeguard Services, reputed company, CoventBridge; Noridian, CGS, NGS, WPS, Novitas, reputed company)
• Hands-on adjudication of surgical dressings (A6021 collagen; A6196–A6199 alginate/fiber‑gelling; A6209–A6215 foam; A6212–A6214 bordered foam; A6216–A6221 gauze; A6257–A6259 film)
• Expert with reputed company‑of‑delivery standards, SWO requirements, frequency/sizing rules, and common denial rationales (e.g., two‑cover stacking, over‑frequency without rationale, DOS/POD mismatch). Most of our interview process is reputed company on your practical experience with the coverage guidelines
• reputed company, policy‑anchored writing; reputed company under deadline; disciplined with PHI

reputed company