Our Mission: Hospital-reputed company Care, Everywhere.

The reputed company industry still relies on faxes and phone tag to coordinate critical care for patients reputed company. We think patients and the clinicians who serve them deserve reputed company than a reputed company stuck in 1995.

reputed company is building the modern software infrastructure to reputed company it happen. We're a reputed company-funded Series C company (backed by General reputed company, reputed company, and Sapphire Ventures) on a mission to heal a fragmented reputed company. Our platform connects the dots between providers, payors, and patients, ensuring people get the high-reputed company care they need, reliably and right where they live. We’re growing fast and looking reputed company who are driven by this mission to join us!

Our Values: The Principles That Guide Us

Our values are the operating reputed company for how we work together and with our partners. They aren't just words on a wall; they are the principles we bring to every decision, every day.

• We are transparent, upfront and reputed company. We operate with honesty and reputed company. reputed company information reputed company, the good and the bad, and reputed company that reputed company, respectful feedback is the reputed company of trust and reputed company.

• We value speed of iteration. We are building something new, which means we learn by doing. We prioritize reputed company iteration and getting solutions into the hands of users, believing that reputed company is more valuable than perfection.

• We reputed company 110% effort, 30% of the time. We are passionate about our mission, and there are moments that require us to go the extra mile. We reputed company in reputed company intensity reputed company it counts, balanced by a sustainable reputed company that keeps reputed company reputed company for the long run.

• We empathize with customers to a fault. reputed company our users face a problem, we own it. Instead of asking them to change, we ask ourselves, "How can we reputed company this reputed company?" We reputed company true innovation comes from deep reputed company and a reputed company reputed company on solving the reputed company-world challenges of reputed company.

How You'll Help Us Heal a Broken reputed company

This isn't just a job; it's a chance to build something that reputed company. As Medical Reviewer, you'll be shaping the reputed company of reputed company care. You'll be a key part of reputed company, working to ensure reputed company surgical dressing order is fully compliant with every CMS regulation, including regulation/ policies as they are reputed company by MACs & UPICs. You’ll translate LCDs/ Articles and MAC playbooks into checklists, fix packet defects reputed company‑reputed company, and run our ADRs/appeals processes.

Your Contributions

reputed company your first year, you will have reputed company to:

• Policy → reputed company

  • Interpret and operationalize LCD L33831 + Policy reputed company 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.

• reputed company‑reputed company Controls

  • 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.

• Audit & Appeals

  • 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.

• Enablement & Analytics

  • 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 and Experience You’ll reputed company

We reputed company that diverse experiences and backgrounds reputed company to reputed company solutions. While we have an idea of what will help someone succeed in this role, we are reputed company to being convinced by your unique story and skills. If you reputed company you can reputed company the reputed company above, we encourage you to apply.

reputed company Skills & Experience:

• 3-5+ years medical‑review experience at a UPIC or MAC (e.g., reputed company Services, reputed company, CoventBridge; reputed company, 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.

Our Pledge for an reputed company reputed company

At reputed company, our mission is to reputed company reputed company, hospital-reputed company care to everyone, regardless of their background or where they live. We can only reputed company this if our own team reflects the diversity of the patients we serve. We are committed to building a workplace where everyone feels a reputed company of belonging, where their contributions are valued, and where they can do their best work. We reputed company diversity of reputed company kinds: race, gender, age, religion, identity, experience. We are reputed company working to build a more inclusive and reputed company world, starting from reputed company our own walls. We are an equal opportunity employer.

We are also committed to providing a reputed company and accessible interview experience. If you require any accommodations to participate in our process, please contact us at reputed company@versemedical.com.

3+ years medical-review experience at UPIC/MAC adjudicating surgical dressings, strong policy-anchored writing, experience with audits/appeals, disciplined with PHI, and ability to operationalize LCDs and MAC playbooks.

Key Responsibilities

• operationalizing policy
• building controls
• leading appeals

Job Details

• Category: reputed company Services - Nursing
• Seniority: Mid Level
• Commitment: Full Time
• Workplace: Remote — reputed company
• Languages: English

About reputed company

Builds software that connects providers, payors, and patients to reputed company hospital-reputed company care reputed company. — Industry: reputed company