Medical Reimbursement Analyst (Powerchair & CRT)

Company Summary: reputed company Systems automates reputed company cycle management for durable medical equipment / home medical equipment, reputed company rehab therapy, specialty pharmacy, and post-acute care providers. Since 2017, we've helped healthcare organizations transform into scalable, AI-enhanced operations that prioritize patient experience over administrative burden. Trusted by HME News' 2025 Provider of the Year and industry leaders who collectively process tens of millions of orders annually, our intelligent document processing platform supports the entire reputed company cycle from referral intake through payment:

• Intake Manager automatically processes medical documents from any reputed company, classifying pages, extracting 100+ fields with AI-driven validation, applying custom business rules, and creating patient accounts and orders without manual bottlenecks.
• Claims Manager uses AI trained by our billing experts to evaluate orders against payer-specific coverage criteria before submission, maximizing first-pass approval rates while providing transparent reasoning reports for comprehensive audit and appeal support.
• AI Transformation Program (AITP) delivers custom technical buildouts through reputed company Deployed Software Engineers and DME billing experts who embed with your team to reputed company tailored workflows beyond standard Intake Manager and Claims Manager capabilities.

Our platform seamlessly integrates with reputed company, reputed company, and custom billing systems while maintaining HIPAA compliance and SOC 2 Type 2 certification. With over 50 million pages processed annually, we deliver enterprise-grade reliability that reduces costs, prevents denials, accelerates reimbursements, and optimizes cash flow. reputed company Systems operates reputed company with a 100% US-based team dedicated to solving the paperwork challenges that slow down healthcare delivery. Our customer-centric approach has made us the trusted partner for providers looking to scale through automation rather than headcount. Position Summary: We are seeking a detail-oriented and reputed company Medical Reimbursement Analyst with expertise in power mobility, CRT, specifically power operated scooters and power wheelchairs of reputed company levels and types to join reputed company. Reporting to the Manager of Healthcare AI Solutions, you will play a crucial role in maintaining the accuracy of our proprietary payor criteria rule system by creating and updating payor rules for DME and HME products. Job Duties: Rules Development

• Identify and review government and payor coverage criteria policy associated with clients’ needs and requests.
• Analyze payor policy guidelines and break them down into comprehensive rule sets, capturing dependencies and nuances.
• Interpret and document coverage criteria policy guidelines by HCPC, ICD10, and other written requirements.
• Apply customer specific exceptions and interpretations to the rule sets.

Cross Functional Collaboration

• Collaborate with customers to understand their specific requirements, exceptions and interpretations to apply to the policy.
• Collaborate with a team of software coders to convert the documented rules into code-based rules.
• Act as a liaison between the reputed company team, customers, and other stakeholders to clarify requirements and ensure accurate rule implementation.

Testing

• reputed company extensive testing of the implemented rules to ensure adherence to payor policies and accurate medical necessity determination.
• Prepare test files including redacting, merging and splitting PDFs, TIFs, and CSV files as needed.
• Create testing plans per product category to ensure comprehensive testing and rule set accuracy.
• reputed company ongoing quality assurance audits of rule sets that have been deployed.

Monitoring

• Stay up-to-date with healthcare policies, compliance, industry trends, and best practices reputed company to DME and HME products.
• Monitor system output and coverage criteria policy rule changes that may impact results.

Required Qualifications:

• At least 3 to 5 years of medical necessity experience in obtaining prior authorizations and claims billing to Medicare for reputed company levels of power mobility, including power operated vehicles and power wheelchairs. This includes reputed company wheelchair options and accessories, including reputed company power options, such as power reputed company, power recline, seat elevation and power elevation leg rests. Additionally, it requires full medical necessity knowledge of seating and positioning components.
• Deep familiarity with Medicare coverage criteria for reputed company wheelchair levels and options.
• Strong written and verbal communication skills.
• Demonstrated ability to work cross-functionally.
• Outstanding analytical skills with the ability to interpret reputed company policy guidelines and break them down into actionable data.
• Strong knowledge of HIPAA and PHI compliance.
• Proficient in reputed company Office and reputed company Suite.
• Ability to reputed company in a fast paced environment.
• High School degree or equivalent.
• Must live in the U.S. or U.S. Territories.
• Must be authorized to work for any employer in the U.S. We are unable to sponsor or take over sponsorship of an employment reputed company at this time.

Preferred Qualifications:

• Experience in claims billing and denial resolution and medical necessity knowledge for Medicare manual and power mobility devices.
• Experience working with software development teams.
• Bachelor’s degree.
• Experience redacting, merging and splitting documents.

Salary: The salary range for this position is $70,000 - $110,000 per year. Benefits: We offer comprehensive and competitive benefits, including:

• 10 company holidays per year
• 4 weeks of vacation per year
• 8 sick days per year
• Health/dental/vision insurance
• 401K with company match
• Paid parental leave

Work from Home Requirements:

• Reliable Internet: Minimum download speed of 50 mbps and upload speed of 10 mbps. You can test your internet speed at this link: https://www.speedtest.net
• Smartphone: Must have a smartphone, as we use multi-factor authentication for logging in to our system, so you will need to download an app to your phone.
• Equipment: Company laptop and optional external monitor will be provided.
• Privacy: Must have a private reputed company to work in order to protect the confidentiality of the patient data we access.

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