Medical Care Specialist
17 hours ago
As a skilled Medical Reviewer, you will be responsible for managing patient wound care records, verifying insurance eligibility and coordinating the supply of essential medical materials.
This role is ideal for individuals with a strong background in clinical wound care and excellent communication skills. You will work closely with the Payer team to determine insurance eligibility and assess wounds eligible for supplies under Medicare guidelines.
Responsibilities:- Managing patient wound care records and verifying insurance eligibility.
- Communicating with the Payer team to determine insurance eligibility and assess wounds eligible for supplies under Medicare guidelines.
- Organizing clinical details, dispensing orders, and documents.
- Entering patient, wound, and dressing data into wound orders and spreadsheets.
- Validating medical necessity for existing orders and documenting changes accurately.
- Communicating via email and phone with staff regarding clinical questions or timeline on order signatures required for delivery date.
- Collaborating with the clinical review team and tracking communication and findings within our system.
- Providing support for tracking systems, IT, and spreadsheet tools for chart reviews and order preparation.
- 2+ years of clinical wound care experience preferred.
- Diploma/Degree in Nursing, Medicine, or related field.
- Excellent English communication skills, both verbal and written.
- Ability to work in a fast-paced environment.
- Strong critical thinking and customer service skills.
This role offers a flexible remote working environment, collaboration with an international team, and contribution to our growing business from the comfort of your home.
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