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Clinical Compliance Reviewer
Tobii DynavoxClinical Compliance Reviewer ensuring clinical documentation meets payer-specific insurance coverage. Supporting funding workflows and providing feedback to SLPs on compliance and quality.
About the role
Key responsibilities & impact- Ensure clinical documentation meets payer-specific insurance coverage criteria
- Perform comprehensive reviews of SLP evaluation reports and related clinical documentation
- Evaluate documentation for completeness, accuracy, and medical necessity
- Support the funding workflow by ensuring clinical documentation is audit-ready
- Collaborate with funding teams to resolve clinical documentation issues
- Provide clear, actionable feedback to SLPs to improve report quality
- Assist in maintaining and updating payer-specific clinical criteria checklists
Requirements
What you’ll need- Bachelor’s Degree and/or 3-5 years healthcare/clinical-related experience
- Background in clinical or clinical-related field
- Knowledge of DME Billing and Prior Authorizations
- Technical writing skills
- Intermediate level skills in Microsoft Word & Excel with ability to learn additional systems as needed
- Communication skills (written, oral and interpersonal)
- Able to work independently and within a team environment
- Interpersonal skills to build relationships with recommenders
- Familiarity of the healthcare field
- Knowledge of Medicare, Medicaid, Commercial 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
Benefits
Comp & perks- Flexible to do what truly matters to you outside of work
- Work culture where collaboration is the norm and individuality is welcomed.
- Opportunities for career growth within a dynamic global company.
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Clinical DocumentationDME BillingPrior AuthorizationsTechnical WritingMicrosoft WordMicrosoft ExcelReport Quality ImprovementAudit-Ready DocumentationHealthcare ComplianceClinical Evaluation
Soft Skills
Communication SkillsInterpersonal SkillsTime ManagementDecision-MakingProblem-Solving