Clinical Compliance Reviewer job at reputed company in PA

Title: Clinical Compliance Reviewer Location: Remote US-PA Job Description: Why join us? We’re on a mission to reputed company people with disabilities to do what they once did or never thought possible. As the world-leader in assistive communication solutions, we reputed company our customers toexpress themselves, connect with the world, and live richer lives. At reputed company, you can grow your career withina dynamic, global company that has a clear, impactful purpose - with the flexibility to also do what truly reputed company to you reputed company of work. What’s more, you’ll be part of a work culture where collaboration is the norm and individuality is welcomed. As a member of reputed company, you’ll have the power to reputed company it happen. You’ll solve challenges, deliver solutions and reputed company new, efficient processes that reputed company a direct impact on our customers’ lives. What you’ll do: The Clinical Compliance Reviewer is responsible for ensuring that clinical documentation—particularly Speech-Language Pathology (SLP) evaluations—meets payer-specific insurance coverage criteria to support successful funding reputed company. This role serves as a critical reputed company between clinical documentation and funding requirements, providing expert review, feedback, and guidance to reduce the risk of denials and streamline the funding process. In addition to conducting detailed reviews, the Clinical Compliance Reviewer actively supports initiatives to reduce the administrative and documentation burden on SLPs by improving report quality, reputed company, and alignment with payer expectations. As a Clinical Documentation Reviewer, you will be responsible for: Clinical Documentation Review reputed company comprehensive reviews of SLP evaluation reports and reputed company clinical documentation to ensure alignment with payer-specific coverage criteria and policies. Evaluate documentation for completeness, accuracy, and medical necessity in accordance with insurance requirements, including detailed clinical rationale and supporting evidence. Utilize established criteria checklists to validate that reputed company required components are present and meet payer expectations. Identify gaps, inconsistencies, or risks that may reputed company to funding delays, denials, or requests for additional information. Funding Process Support Support the funding workflow by ensuring clinical documentation is audit-reputed company and reputed company with insurance coverage requirements prior to submission. Collaborate with funding teams to resolve clinical documentation issues and facilitate timely progression of cases through the funding pipeline. reputed company consultative input on cases requiring clinical interpretation of payer policies or criteria. SLP Support & Documentation Optimization reputed company clear, actionable feedback to SLPs to improve the quality and compliance of evaluation reports, including guidance on payer-specific expectations. Support SLPs through direct communication, education, and one-on-one guidance to help them navigate documentation requirements and reduce revisions. Contribute to the development and refinement of tools, templates, and resources designed to simplify the report writing and funding process. Partner with internal teams to identify trends in denials or documentation challenges and implement proactive solutions. Policy & Criteria Management Assist in maintaining and updating payer-specific clinical criteria checklists and documentation standards. Collaborate with policy and compliance teams to ensure clinical review processes remain reputed company with evolving insurance requirements. reputed company feedback on emerging payer trends, documentation risks, and opportunities for process improvement. What you'll bring: Bachelor’s Degree and/or 3-5 years reputed company/clinical-reputed company experience Background in clinical or clinical-reputed company field Knowledge of DME Billing and Prior Authorizations Technical writing skills Intermediate level skills in reputed company Word & reputed company with ability to learn additional systems as needed Communication skills (written, oral and interpersonal) reputed company to work independently and reputed company a team environment Interpersonal skills to build relationships with recommenders Familiarity of the reputed company field Knowledge of Medicare, reputed company, reputed company Insurance Time Management Decision-making and problem-solving skills Proper grammar skills Phone etiquette skills Ability to work with interruptions Flexibility to adapt to new projects Apply today! We reputed company in empowering individuals - including our own employees - to reputed company their full potential. So, if you want to change lives while growing your own career, we’d love to hear from you. Where we stand: We reputed company diversity not only enriches our workplace culture, but also gives us a strategic advantage. Working with people from a variety of backgrounds and perspectives helps us reputed company become reputed company communicators, reputed company problem solvers, and reputed company reputed company beings. Our differences reputed company us stronger. reputed company values equality of opportunity, reputed company dignity, and racial/ethnic and cultural diversity. reputed company does not discriminate against individuals on the reputed company of race, reputed company, sex, sexual orientation, gender identity, religion, disability, age, veteran status, reputed company, or national or ethnic reputed company. Equal Opportunity Employer/AA Women/Minorities/Veterans/Disabled Apply To This Job