Reviewer

• Review patient documentation for each device category against CMS LCD criteria and payer-specific requirements.
• Identify documentation gaps and generate structured deficiency notices to clinicians and prescribers.
• Build and maintain criteria checklists per code block, aligned with the Clinical Intelligence Lead's agent guides.
• Audit HITL team reviews for criteria accuracy and consistency.
• Flag payer-specific deviations (e.g., UHC requirements that differ from Medicare) and document them in the policy library.
• Collaborate with the Protocol Specialist to update criteria sets when LCDs change.
• Support prior authorization packet assembly, ensuring each packet maps to the coverage criteria for the relevant payer.

DME Documentation Criteria Reviewer

• Review and edit AI critique of writing samples using professional criteria
• Articulate evaluation methods for writing quality in your domain
• Participate in live workshops to explain edits

See all jobs on JobTailor

DME Documentation Criteria Reviewer

Expert Reviewer – Short-term Research Project