The Medical Review Nurse will evaluate DMEPOS orders and medical records to ensure compliance with CMS regulations and medical necessity. They will also serve as a liaison between healthcare providers and internal teams to address documentation gaps and improve billing quality.
The Customer Experience Associate will manage inbound clinic inquiries and resolve order-related issues through phone, email, and chat. They will also collaborate with internal teams to improve operational workflows and advocate for the needs of clinics and patients.
Ensure surgical dressing orders comply with CMS regulations and MAC/UPIC policies by translating guidelines into operational checklists. Lead the ADR and appeals process while establishing QA controls for clinical completeness and billing correctness.
Lead national enrollment operations by managing the end-to-end lifecycle of EDI, EFT, and ERA connections for thousands of payers. Monitor transaction loops and resolve electronic connection issues to ensure uninterrupted financial operations.
