Medical Reviewer for Surgical Dressings

Job Summary

A company is looking for a Medical Reviewer, Surgical Dressings.

Key Responsibilities

• Ensure surgical dressing orders comply with CMS regulations and policies
• Lead audit and appeals processes, including UPIC/MAC ADR responses
• Train team members on documentation requirements and track relevant metrics

Required Qualifications

• 3-5+ years of medical review experience at a UPIC or MAC
• Hands-on adjudication experience with various surgical dressings
• Expertise in proof of delivery standards and common denial rationales
• Strong writing skills anchored in policy
• Ability to work calmly under deadlines while handling PHI