💼 About This Role

You'll shape the future of at-home care by ensuring surgical dressing orders comply with CMS regulations. Your core impact is translating LCDs and MAC playbooks into actionable checklists and fixing packet defects pre-bill. This role stands out for its focus on policy-driven quality assurance in a mission-driven startup.

🎯 What You'll Do

• Interpret LCD L33831 and publish practical coverage rules
• Build a two-gate QA for clinical completeness and billing correctness
• Lead UPIC/MAC ADR responses pre- and post-payment
• Train customer-facing teams on documentation satisfying LCD

📋 Requirements

• 3-5+ years of medical-review experience at a UPIC or MAC
• Hands-on adjudication of surgical dressings (A6021 collagen, A6196-A6199, A6209-A6215, etc.)
• Expert with proof-of-delivery standards, SWO requirements, and frequency/sizing rules

✨ Nice to Have

• Experience with collagen, alginate, foam, film, hydrocolloid products
• Knowledge of A-modifier usage (wound count) and KX/GA/GZ/EY modifiers
• Background in appeals library creation and policy citation

🎁 Benefits & Perks

• 💰 Base salary up to $105,000 depending on experience
• 🏥 100% health insurance premium covered
• 🦷 Dental and vision insurance for you and dependents
• 🏦 401(k) plan (no company match currently)
• 🚀 Rapid career advancement opportunities in a growing company

📨 Hiring Process

Estimated timeline: 2-4 weeks · AI estimate

1. 1Recruiter Screen· 30 min
2. 2Technical Interview (Coverage Guidelines)· 60 min
3. 3Hiring Manager Interview· 45 min