Medical Reimbursement Analyst (Powerchair & CRT)

About the position We are seeking a detail-oriented and experienced Medical Reimbursement Analyst with expertise in power mobility, CRT, specifically power operated scooters and power wheelchairs of all levels and types to join our team. 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.

Responsibilities

• 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 coder team, customers, and other stakeholders to clarify requirements and ensure accurate rule implementation.
• Testing Perform 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.
• Perform 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 related to DME and HME products.
• Monitor system output and coverage criteria policy rule changes that may impact results.

Requirements

• At least 3 to 5 years of medical necessity experience in obtaining prior authorizations and claims billing to Medicare for all levels of power mobility, including power operated vehicles and power wheelchairs. This includes all wheelchair options and accessories, including all power options, such as power tilt, 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 all wheelchair levels and options.
• Strong written and verbal communication skills.
• Demonstrated ability to work cross-functionally.
• Outstanding analytical skills with the ability to interpret complex policy guidelines and break them down into actionable data.
• Strong knowledge of HIPAA and PHI compliance.
• Proficient in Microsoft Office and Google Suite.
• Ability to thrive 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 visa at this time.
• 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.
• Privacy : Must have a private place to work in order to protect the confidentiality of the patient data we access.

Nice-to-haves

• 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.

Benefits

• 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

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