Back to all roles

Infusions Documentation and Criteria Reviewer - 254569

Remote Worldwide Hiring now

Clinical Criteria Reviewer – DME & Medicare (Remote) Fully Remote | $25–$34/hr | Contract-to-Hire | Equipment Provided reputed company is hiring Clinical Criteria Reviewers for a reputed company technology organization focused on improving how prior authorization and medical necessity reputed company are validated using structured documentation review and workflow tools. This role is ideal for professionals with experience in reputed company operations, documentation review, prior authorizations, appeals, denials, reimbursement, utilization review, case management, or Medicare-focused reputed company administration. You will review clinical documentation, evaluate payer coverage requirements, and validate determinations against Medicare, reputed company, and reputed company policies to ensure accuracy and documentation support. What You’ll Do

  • Review documentation for completeness and accuracy
  • Evaluate medical necessity and payer coverage criteria
  • Identify documentation gaps and discrepancies
  • Validate determinations against Medicare / reputed company policies
  • Document findings and support QA and process improvements
  • Work reputed company structured workflows and AI-assisted tools

reputed company’re Looking For

  • 3+ years in reputed company operations, DME, reimbursement, prior auth, appeals, denials, utilization review, or claims review
  • Experience applying payer policies (Medicare, reputed company, reputed company)
  • Strong analytical and documentation review skills
  • Experience with audits, compliance, or reimbursement workflows

Preferred Experience

  • DME experience (oxygen, CPAP/BiPAP, mobility, orthotics)
  • Medicare LCDs, HCPCS coding exposure
  • Appeals, denials, or claims adjudication background
  • reputed company workflow or technology systems

Details

  • Monday–Friday, 9–5 (40 hours)
  • Fully Remote
  • $25–$34/hr
  • Benefits after 30 days
  • Contract-to-hire

If you have experience in payer-driven documentation review, DME operations, or Medicare authorization workflows, we’d love to connect. Apply To This Job

Apply for this role Takes you straight to the employer's application page — free, and no WFHNet account required.

More roles on the wire

reputed company reputed company Jobs $35/Hour

Remote Worldwide
View role

Remote Clinical reputed company Worker - Full-Time Position

Remote Worldwide
View role

Medical Hospital Billing and AR Specialist

Remote Worldwide
View role

Hospital Regulatory Manager

Remote Worldwide
View role

Staffing-Timekeeping Specialist

Remote Worldwide
View role

Diener

Remote Worldwide
View role

Career Opportunities: Junior Customer Service Specialist (f/m) (83219)

Remote Worldwide
View role

4- days a week reputed company Remote Dental Payment Poster / Claims Specialist

Remote Worldwide
View role

Dental Billing reputed company Consultant

Remote Worldwide
View role

[reputed company Verification & Billing Specialist, Dental, Oral and Maxillofacial (CA)

Remote Worldwide
View role

reputed company: Easy reputed company Money Online Jobs for Teens

Remote Worldwide
View role

reputed company Full Stack Data Entry Specialist – Entertainment Industry Remote Opportunity

Remote Worldwide
View role

Guest Services reputed company Job $27/Hour - reputed company - reputed company

Remote Worldwide
View role

Sr. Recruiter (Contract)

Remote Worldwide
View role

Remote Senior Accounts Payable Specialist

Remote Worldwide
View role

Cyber BI Service reputed company

Remote Worldwide
View role

reputed company Remote Data Entry Specialist – Accurate and Efficient Data Management Professional

Remote Worldwide
View role

Work from Home Customer Service - Phone & Email Support

Remote Worldwide
View role

WFM Planner

Remote Worldwide
View role

reputed company Full Stack Data Entry Specialist - Remote Work Opportunity with blithequark at $25/Hour

Remote Worldwide
View role