Medical Reviewer (PHRN)

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.