[Remote] Clinical Compliance Reviewer

Note: The job is a remote job and is open to candidates in USA. Tobii Dynavox is a world-leader in assistive communication solutions, dedicated to empowering people with disabilities. The Clinical Compliance Reviewer ensures that clinical documentation meets payer-specific insurance coverage criteria, providing expert review and feedback to streamline funding processes.

Responsibilities

• Perform comprehensive reviews of SLP evaluation reports and related clinical documentation to ensure alignment with payer-specific coverage criteria and policies
• Evaluate documentation for completeness, accuracy, and medical necessity in accordance with insurance requirements, including detailed clinical rationale and supporting evidence
• Utilize established criteria checklists to validate that all required components are present and meet payer expectations
• Identify gaps, inconsistencies, or risks that may lead to funding delays, denials, or requests for additional information
• Support the funding workflow by ensuring clinical documentation is audit-ready and aligned with insurance coverage requirements prior to submission
• Collaborate with funding teams to resolve clinical documentation issues and facilitate timely progression of cases through the funding pipeline
• Provide consultative input on cases requiring clinical interpretation of payer policies or criteria
• Provide clear, actionable feedback to SLPs to improve the quality and compliance of evaluation reports, including guidance on payer-specific expectations
• Support SLPs through direct communication, education, and one-on-one guidance to help them navigate documentation requirements and reduce revisions
• Contribute to the development and refinement of tools, templates, and resources designed to simplify the report writing and funding process
• Partner with internal teams to identify trends in denials or documentation challenges and implement proactive solutions
• Assist in maintaining and updating payer-specific clinical criteria checklists and documentation standards
• Collaborate with policy and compliance teams to ensure clinical review processes remain aligned with evolving insurance requirements
• Provide feedback on emerging payer trends, documentation risks, and opportunities for process improvement

Skills

• Bachelor's Degree and/or 3-5 years healthcare/clinical-related experience
• Background in clinical or clinical-related field
• Knowledge of DME Billing and Prior Authorizations
• Technical writing skills
• Intermediate level skills in Microsoft Word & Excel with ability to learn additional systems as needed
• Communication skills (written, oral and interpersonal)
• Able to work independently and within a team environment
• Interpersonal skills to build relationships with recommenders
• Familiarity of the healthcare field
• Knowledge of Medicare, Medicaid, Commercial Insurance
• Time Management
• Decision-making and problem-solving skills
• Proper grammar skills
• Phone etiquette skills
• Ability to work with interruptions
• Flexibility to adapt to new projects

Company Overview