Clinical Compliance Reviewer

Job Summary

Ensuring clinical documentation meets payer-specific insurance coverage criteria, the full-time Clinical Compliance Reviewer will perform detailed evaluations of Speech-Language Pathology reports and collaborate with funding teams to streamline the funding process in a remote setting.

Key responsibilities

• Conduct comprehensive reviews of SLP evaluation reports to ensure alignment with payer coverage criteria
• Support the funding workflow by ensuring documentation is audit-ready and compliant prior to submission
• Provide actionable feedback to SLPs to enhance report quality and compliance with payer expectations

Required qualifications

• Bachelor's Degree and/or 3-5 years of healthcare or clinical-related experience
• Knowledge of DME Billing and Prior Authorizations
• Technical writing skills
• Intermediate proficiency in Microsoft Word and Excel
• Familiarity with Medicare, Medicaid, and Commercial Insurance