Medical Reviewer, Surgical Dressings jobs in United States
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Verse Medical · 1 month ago

Medical Reviewer, Surgical Dressings

positionUnited States
timeFull-time
remoteRemote
seniorityMid, Senior Level
money$0/yr - $110K/yr
date3+ years exp

Verse Medical is a well-funded Series C company on a mission to heal a fragmented healthcare system by building modern software infrastructure. As a Medical Reviewer for Surgical Dressings, you will ensure compliance with CMS regulations and enhance the quality of at-home care by operationalizing policies and leading audit and appeals processes.

ComputerHealth CareInsurance
badNo H1Bnote

Responsibilities

Interpret and operationalize LCD L33831 + Policy Article for surgical dressings; publish practical rules (when covered, limits, documentation phrases)
Stand up 'go/no-go' criteria for collagen, alginate/fiber-gelling, foam, film, hydrocolloid; codify A-modifier (wound count) usage, KX/GA/GZ/EY, sizing, quantity/frequency math
Build a 2-gate QA (1: clinical completeness; 2: billing correctness) and pilot it on all surgical-dressing claims
Create/upgrade templates for various outreach
Lead UPIC/MAC ADR responses (pre- and post-pay)
Coach internal billing team; establish a reusable appeals library with policy citations and exemplars
Train customer-facing team members (30-min modules) and billers on the specific documentation that satisfies the LCD
Define and track metrics: initial denial %, appeal win %, ADR turnaround, % packets with signed POD, top-defect Pareto

Qualification

Medical review experienceSurgical dressings adjudicationProof-of-delivery standardsPolicy-anchored writingCalm under deadlineDisciplined with PHI

Required

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 (e.g., two‑cover stacking, over‑frequency without rationale, DOS/POD mismatch). Most of our interview process is focused on your practical experience with the coverage guidelines
Crisp, policy‑anchored writing; calm under deadline; disciplined with PHI

Benefits

Comprehensive Health & Wellness: We cover 100% of your health insurance premium and provide access to high-quality dental and vision insurance plans for you and your dependents.
Plan for the Future: We offer a 401(k) plan to help you save for your future. At this time, the company does not offer a 401(k) match.

Company

Verse Medical

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Verse Medical provides and delivers the lowest prices on health products with fantastic service.
dateFounded in 2018
location
New York, New York, USA
people-size51-200 employees
web-link
https://versemedical.com/

Funding

Current Stage
Growth Stage
Total Funding
$3M
Key Investors
Abstract
2021-03-15Seed· $3M
2020-01-01Seed
2018-08-22Pre Seed

Leadership Team

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Dhaivat Pandya
CEO
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Recent News

PR Newswire
Verge Medical Acquires RoVo™ System to Advance Peripheral Embolic Protection
2025-06-30
Company data provided by crunchbase