Document Reviewer

This opportunity is open to remote work in the following approved states: AL, AK, FL, GA, ID, IN, IO, KS, KY, LA, MS, NE, NC, ND, OH, PA, SC, TN, TX, UT, WV, WI, WY. Specific counties and cities within these states may require further approval. In FL, PA, TX and WI, in-office and hybrid work may also be available

Start Date: May 27th, 2025

Non Negotiable Pay Rate: $17.75/hour

We are hiring for a medical insurance company and in this role you will be responsible for the thorough review and evaluation of applications submitted by clinics seeking to enroll in the Medicare program.

The role ensures that all applicants meet the necessary regulatory and compliance standards set by the Centers for Medicare & Medicaid Services (CMS). The reviewer works closely with clinics, ensuring they understand the requirements and helping facilitate a smooth enrollment process.

Key Responsibilities:

Application Review:

• Evaluate submitted applications for completeness, accuracy, and compliance with Medicare guidelines.
• Ensure that clinics meet all eligibility criteria, including proper licensing, credentialing of healthcare providers, and compliance with state and federal regulations.

Documentation Verification:

• Verify the authenticity and accuracy of supporting documentation, including licenses, certifications, and facility credentials.
• Cross-check application information against state and federal databases to confirm compliance with legal and regulatory requirements.

Compliance Assurance:

• Identify any discrepancies, omissions, or non-compliance issues in applications and communicate these to the clinic with recommendations for corrective action.
• Ensure that clinics meet CMS requirements, including quality standards, patient care protocols, and operational practices.

Communication:

• Provide clear and detailed feedback to clinic representatives regarding the status of their application.
• Serve as a point of contact for clinics during the application process, answering questions and providing guidance on Medicare requirements.

Record Keeping:

• Maintain accurate and organized records of all applications, including notes on application status, communications, and final determinations.
• Prepare reports and summaries of application outcomes for internal and external stakeholders.

Continuous Improvement:

• Stay updated on changes in Medicare regulations, policies, and procedures to ensure that application reviews are in line with the latest standards.
• Contribute to the development and improvement of application review processes to enhance efficiency and accuracy.