Medical Review Specialist DME

2 weeks ago


Davao City, Davao, Philippines Med Supply US Full time
About the Job

Med Supply US is a well-established home medical supply company dedicated to assisting patients with complex medical needs. Specializing in Continuous Glucose Monitors (CGMs) and diabetes products, we pride ourselves on our collaborative work environment and commitment to providing exceptional care.

Job Summary:

We are seeking a DME Medical Review Specialist to ensure the proper utilization and billing of Durable Medical Equipment. This role involves reviewing medical documentation and claims to validate the medical necessity, compliance with regulations, and accuracy of services provided.

Key Responsibilities:
  • Medical Documentation Review: Assess medical records to determine the necessity of DME services.
  • Claims Evaluation: Verify accuracy and compliance of insurance claims.
  • Utilization Review: Evaluate appropriateness of DME services for patients.
  • Regulatory Compliance: Stay informed on healthcare regulations.
  • Communication: Collaborate with healthcare providers and insurance companies.
  • Documentation: Maintain accurate records of reviews and actions taken.
  • Quality Improvement: Identify areas for process enhancements.
  • Training and Education: Develop training programs on regulatory requirements.
  • Auditing: Conduct audits to assess compliance of DME claims.
  • Reporting: Prepare reports on review outcomes and compliance issues.
  • Data Analysis: Analyze trends in DME utilization.
  • Customer Service: Assist patients and healthcare providers with DME inquiries.
Qualifications:
  • Bachelor's degree in a healthcare-related field or relevant experience.
  • Knowledge of DME, Medicare, and Medicaid regulations.
  • Strong understanding of medical terminology and billing procedures.
  • Analytical skills and attention to detail.
  • Excellent written and verbal communication.
  • Proficiency in using computer software for analysis.
Experience:
  • Prior experience in healthcare reimbursement or medical billing preferred.
  • Familiarity with auditing processes is an advantage.
  • Knowledge of electronic health records beneficial.

The DME Medical Review Specialist is crucial for ensuring patient care quality and regulatory compliance in DME services. Join us in upholding the highest standards in healthcare.



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