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 is responsible for ensuring that clinical documentation meets payer-specific insurance coverage criteria, providing expert review and guidance to streamline the funding process.
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