Medical Reviewer, Surgical Dressings

Verse

DME Medical Reviewer ensuring compliance with CMS regulations for surgical dressing orders at Verse Medical. Working remotely to shape the future of at-home care.

Posted 5/4/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $65,000 - $105,000 per yearWebsite

About the role

Key responsibilities & impact

Ensure each surgical dressing order is fully compliant with every CMS regulation
Interpret and operationalize LCD L33831 + Policy Article for surgical dressings
Build a 2‑gate QA on all surgical‑dressing claims
Lead UPIC/MAC ADR responses (pre‑ and post‑pay)
Train customer-facing team members and billers on specific documentation

Requirements

What you’ll need

3-5+ years medical-review experience at a UPIC or MAC (e.g., Safeguard Services, Qlarant, CoventBridge; Noridian, CGS, NGS, WPS, Novitas, Palmetto)
Hands-on adjudication of surgical dressings (A6021 collagen; A6196–A6199 alginate/fiber‑gelling; A6209–A6215 foam; A6212–A6214 bordered foam; A6216–A6221 gauze; A6257–A6259 film)
Expert with proof‑of‑delivery standards, SWO requirements, frequency/sizing rules, and common denial rationales
Crisp, policy‑anchored writing; calm under deadline; disciplined with PHI.

Benefits

Comp & perks

100% health insurance premium coverage
Access to high-quality dental and vision insurance plans
401(k) plan to help save for the future

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

medical-review experienceadjudication of surgical dressingsproof-of-delivery standardsSWO requirementsfrequency/sizing rulesdenial rationalesCMS complianceLCD L33831 interpretationsurgical dressing claims QAdocumentation training

Soft Skills

policy-anchored writingcalm under deadlinediscipline with PHIleadershiptrainingcommunication