Medical Review Specialist: DME Compliance & CMS Audits

Verse Medical, Inc.; United States; On-site; USD 80,000 - 90,000; Full time

Job summary

Verse Medical, Inc. is seeking a Medical Reviewer to ensure DME orders comply with CMS regulations, LCDs, and LCAs, acting as the bridge between policy requirements and operational excellence.

You will review medical records for medical necessity, educate providers on coverage criteria, and safeguard PHI while adhering to HIPAA standards in a fast-paced environment.

This role offers a meaningful opportunity to advance at-home care and improve the accuracy of medical billing in the United States.

Qualifications

• 3-5+ years of experience with DME pre-authorizations, DME utilization management reviews and/or DME claim audit processes.
• Proficiency with medical review software/EHR platforms.
• Excellent written and verbal communication skills with the ability to convey complex policy requirements clearly.

Responsibilities

• Medical Necessity & Compliance Review: Review DMEPOS orders, progress notes, and medical records against coverage policies to confirm medical necessity across diverse DME categories.
• Provider Education: Communicate findings clearly with healthcare providers and internal teams to bridge documentation gaps and educate stakeholders on evolving coverage criteria.
• Data Security: Maintain strict compliance with HIPAA and enforce disciplined handling of PHI across all workflows.

Skills

Communication skills

HIPAA compliance

Team collaboration

Adaptability

Tools

EHR platforms

Job description

Verse Medical, Inc. is seeking a Medical Reviewer to ensure DME orders comply with CMS regulations, LCDs, and LCAs, acting as the bridge between policy requirements and operational excellence.

You will review medical records for medical necessity, educate providers on coverage criteria, and safeguard PHI while adhering to HIPAA standards in a fast-paced environment.

This role offers a meaningful opportunity to advance at-home care and improve the accuracy of medical billing in the United States.