[Remote] Medical Reviewer, Surgical Dressings at Verse Medical

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

3-5+ years medical-review experience
Ability to interpret and operationalize LCDs and policy articles
Experience with CMS regulations and policies as applied by MACs and UPICs
Strong analytical and problem-solving skills
Ability to translate complex information into practical checklists and guidelines
Excellent communication and training skills
Experience with pre-bill controls and audit/appeals processes
Ability to work independently and as part of a team
Strong attention to detail and ability to prioritize tasks
Familiarity with medical terminology and coding systems (e.g. ICD-10, CPT)

Responsibilities

Interpret and operationalize LCD L33831 and policy articles for surgical dressings
Translate LCDs and policy articles into practical checklists and guidelines
Develop and implement pre-bill controls to ensure clinical completeness and billing correctness
Lead UPIC/MAC ADR responses (pre- and post-pay)
Coach internal billing team on specific documentation requirements
Develop and track metrics related to initial denial rates, appeal win rates, ADR turnaround times, and other key performance indicators
Train customer-facing team members and billers on specific documentation requirements
Enablement & Analytics: Define and track metrics, and develop reusable appeals library with policy citations and exemplars
Policy → Practice: Interpret and operationalize LCDs and policy articles, and publish practical rules and guidelines
Pre-Bill Controls: Build and pilot a 2-gate QA process for surgical-dressing claims

Verse Medical

Develops remote care healthcare software solutions

About Verse Medical

Verse specializes in cutting-edge software solutions designed to facilitate high-quality healthcare remotely. Their approach is particularly pivotal in a world increasingly focused on efficient and reliable home-based medical care. With a strong emphasis on developing technologies that provide hospital-quality treatment from the comfort of one’s home, working at this company offers the opportunity to be at the forefront of telehealth and remote care innovation while contributing to a transformative shift in how healthcare services are delivered globally.

New York City, New YorkHeadquarters

2018Year Founded

$12.6MTotal Funding

SEEDCompany Stage

HealthcareIndustries

11-50Employees

Benefits

Health Insurance

Dental Insurance

401(k) Retirement Plan

Risks

Increased competition from online pharmacies like Amazon Pharmacy.

Rising raw material costs due to global supply chain issues.

Potential regulatory changes could impact Verse Medical's pricing strategies.

Differentiation

Verse Medical offers the lowest prices on health products with excellent service.

The company focuses on delivering personalized and customized health products.

Verse Medical is positioned to capitalize on the growing trend of eco-friendly health products.

Upsides

Telemedicine adoption allows Verse Medical to expand services to remote areas.

The global e-commerce market growth offers expansion opportunities for Verse Medical.

AI in customer service can enhance Verse Medical's service quality and efficiency.

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