Part-Time DME Documentation & Criteria Reviewer - Remote

Overview

This role involves reviewing clinical documentation and assessing model-generated qualification outcomes in the DME space, ensuring alignment with payer standards.

In Short

• Part-time contract position focused on DME documentation review.
• Review model outputs to improve criteria determinations.
• Flag incorrect determinations with structured feedback.
• Compare documentation against Medicare, Medicaid, and commercial payer policies.
• Analyze insurance policies to validate qualification logic.
• Collaborate with internal teams to refine documentation review standards.
• Maintain clear documentation of findings.
• Requires hands-on DME experience in relevant roles.
• Comfortable reviewing insurance coverage policies.
• Highly organized and detail-focused.

Requirements

• 4+ years of DME experience, ideally in documentation review, intake, audits, or compliance.
• Familiarity with Medicare, Medicaid, and commercial payer guidelines.
• Understanding of HCPCS codes and DME categories.
• Experience with audits or appeals is a plus.
• Familiarity with decision logic platforms is helpful.

Benefits

• Opportunity to shape technology supporting accurate qualifications.
• Work in a remote team setting.
• Utilize DME knowledge meaningfully.