Medical Reviewer; PHRN

At Limitlessli, we specialize in recruiting, hiring, and managing high-caliber remote staff for dynamic and growing healthcare facilities. Leveraging our extensive global network, we connect clients with highly qualified professionals, offering meticulously tailored services to meet our clients' unique business needs.

Are you a skilled Medical Reviewer with a focus on wound care? Our East Coast-based healthcare client is looking for a dedicated Medical Reviewer - Wound Care to join their team! In this role, you'll manage patient wound care records, verify insurance eligibility, and coordinate the supply of essential medical materials. Your expertise in meticulous documentation and effective communication will play a crucial role in ensuring patients receive the care they need.

If you're passionate about wound care and eager to make a meaningful impact, we'd love to hear from you!

This position is remote and offers you the flexibility of working from home.

• Responsible for records progress for wound care intake
• Pull reports and documents for patients who are at home with wounds at time of review
• Communicate with the Payer team to determine which patients have insurance eligibility
  Assess which wounds are eligible for supplies under Medicare medical necessity guidelines
• Store and effectively organize records of clinical details, dispensing orders, and documents
• Enter patient, wound, and dressing data into wound orders and onto spreadsheets
• Add product specifics to spreadsheets, support product verification steps to prepare orders including sizes, quantities, preferred brands
• Validate medical necessity for existing orders, document changes accurately
• Communicate via email and phone with staff at homes, clarifications on clinical questions or timeline on order signatures required for delivery date
• Collaborate with the clinical review team in other service lines may be required
• Tracking communication and findings within the company system
• Provide support for tracking systems, IT, and spreadsheet tools for chart reviews and order preparation
• Support streamlining communication and workflow with resources available
• Maintain working knowledge and tracking of product billing and reimbursement data
• Product research, cost-effective and comparable product resources

• 2+ years of clinical wound care experience preferred
• Diploma/ Degree in Nursing, Medicine or related field
• Excellent English communication skills, both verbal and written
• Ability to work in a fast-paced environment
• Strong critical thinking and customer service skills
• Knowledge of eligibility, Medicare and product guidelines for education sessions i.e., Noridian LCD.

US Eastern Standard Time (EST) - 9am to 6pm

We embrace the flexibility and convenience of a remote working environment, and you will collaborate with an international team while contributing to our growing business, all from the comfort of your home.

You will need to have some essential tools – a reliable computer and noise-canceling headset, a second monitor for enhanced productivity, and a stable internet connection. You'll also be required to have a backup internet connection, ensuring that you're well-equipped to complete your work seamlessly.

Don't miss out on this opportunity – apply now and become a valuable member of the Limitlessli team! If you're interested in what you have read, then we invite you to take the next step and submit your application.