DME Criteria & Documentation Analyst

Hike Medical Inc.; San Francisco (CA); On-site; USD 60,000 - 80,000; Full time

Job summary

Hike Medical Inc. is seeking a DME Documentation Criteria Reviewer to ensure compliance with medical necessity requirements and review patient documentation. In this role, you will identify gaps in documentation and collaborate closely with clinicians.

The ideal candidate will have over 3 years of experience in DMEPOS documentation review, a strong grasp of CMS Local Coverage Determinations, and familiarity with payer requirements. This position offers a unique opportunity to contribute to the healthcare landscape.

Qualifications

• 3+ years of experience reviewing DMEPOS documentation in a relevant clinical or billing role.
• Solid understanding of CMS Local Coverage Determinations and Policy Articles.
• Experience with prior authorization for major payers like UHC and Aetna.

Responsibilities

• Review patient documentation per device category against CMS LCD criteria.
• Identify documentation gaps and generate deficiency notices.
• Build criteria checklists aligned with agent guides.

Skills

DMEPOS documentation review

CMS Local Coverage Determinations

Prior authorization processes

Detail-oriented

Structured checklists

Job description

Hike Medical Inc. is seeking a DME Documentation Criteria Reviewer to ensure compliance with medical necessity requirements and review patient documentation. In this role, you will identify gaps in documentation and collaborate closely with clinicians.

The ideal candidate will have over 3 years of experience in DMEPOS documentation review, a strong grasp of CMS Local Coverage Determinations, and familiarity with payer requirements. This position offers a unique opportunity to contribute to the healthcare landscape.