Clinical Wound Care Specialist

22 hours ago

Mabalacat, Central Luzon, Philippines beBeeMedicare Full time $60,000 - $80,000
Medical Reviewer Position

We are seeking a skilled professional to manage patient wound care records, verify insurance eligibility, and coordinate the supply of essential medical materials.

Main Responsibilities:
  • Responsible for recording progress in wound care intake
  • Pull reports and documents for patients with wounds at home during review
  • Communicate with the payer team to determine which patients have insurance eligibility
    Assess which wounds are eligible for supplies under Medicare medical necessity guidelines
  • Store and organize clinical details, dispensing orders, and documents effectively
  • Enter patient, wound, and dressing data into wound orders and onto spreadsheets
  • Add product specifics to spreadsheets, support product verification steps to prepare orders including sizes, quantities, preferred brands
  • Validate medical necessity for existing orders, document changes accurately
  • Communicate via email and phone with staff at homes regarding clinical questions or timeline on order signatures required for delivery date
  • Collaborate with the clinical review team in other service lines may be required
  • Track communication and findings within the company system
  • Provide support for tracking systems, IT, and spreadsheet tools for chart reviews and order preparation
  • Support streamlining communication and workflow with resources available
  • Maintain working knowledge and tracking of product billing and reimbursement data
  • Research cost-effective and comparable product resources
Requirements:
  • Minimum 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
  • Knowledge of eligibility, Medicare and product guidelines

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