Clinical Wound Care Specialist
3 days ago
Are you a skilled professional looking for a challenging role in wound care? We are seeking an experienced Medical Reviewer to join our team.
Job Summary:The Medical Reviewer will be responsible for managing patient wound care records, verifying insurance eligibility, and coordinating the supply of essential medical materials.
Responsibilities:- Progress patient wound care intake records by gathering and analyzing data from various sources.
- Pull reports and documents for patients with wounds under review, ensuring timely and accurate completion.
- Communicate with the Payer team to determine insurance eligibility and assess medical necessity for supplies under Medicare guidelines, resolving any discrepancies promptly.
- Organize clinical details, dispensing orders, and documents in a clear and concise manner.
- Enter patient, wound, and dressing data into spreadsheets, maintaining accurate and up-to-date records.
- Validate medical necessity for existing orders and document changes accurately, ensuring compliance with regulatory requirements.
- Communicate with staff via email and phone on clinical questions or timeline requirements, providing timely support and guidance.
- Collaborate with the clinical review team to ensure seamless workflow and effective decision-making.
- 2+ years of clinical wound care experience preferred, with a strong foundation in medical procedures and policies.
- Diploma/ Degree in Nursing, Medicine or related field, with relevant certifications and training.
- Excellent English communication skills, with the ability to articulate complex information clearly and concisely.
- Ability to work in a fast-paced environment, prioritizing tasks and managing multiple deadlines effectively.
- Strong critical thinking and customer service skills, with a focus on delivering exceptional results and building strong relationships.
- Knowledge of eligibility, Medicare and product guidelines, with a commitment to staying up-to-date with industry developments and best practices.
A remote working environment with flexible hours, collaboration with an international team, and opportunities for professional growth and development.
You will need reliable equipment, noise-canceling headset, second monitor, and stable internet connection to perform your duties effectively.
Additional Information:Our team is committed to delivering high-quality services and supporting the needs of our clients. If you are a motivated and detail-oriented individual looking for a challenging role in wound care, we encourage you to apply.
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