DME Documentation & Criteria Reviewer

Responsibilities

• Flag incorrect determinations, including false positives, false negatives, and unclear logic, with structured feedback
• Compare documentation against Medicare, Medicaid, and commercial payer coverage policies
• Analyze source materials (insurance policies, LCDs, etc.) to help validate qualification logic
• Work closely with internal teams to refine prompting logic and improve documentation review standards
• Maintain clear documentation of findings and contribute to process improvements

Requirements

• Hands-on DME experience in roles such as intake, documentation review, audits, or quality/compliance
• Ability to identify when documentation meets or fails to meet payer requirements
• Comfort reviewing insurance coverage policies and applying them to real-world cases
• Highly organized and detail-focused
• Ability to work independently in a remote team setting

Preferred Qualifications

• 4+ years working in DME, ideally in documentation review, intake, audits, or compliance roles
• Familiarity with Medicare, Medicaid, and commercial payer guidelines for DME
• Understanding of HCPCS codes and common DME categories (respiratory, mobility, maternal health)
• Experience with audits or appeals
• Familiarity with decision logic or rules-based platforms

Benefits

• Unlimited PTO
• 100% paid employee health benefit options
• Employer-funded 401(k) match
• Competitive parental leave
• Free lunch and snacks

About the Company

Tennr uses AI to prevent delays and denials in medical referrals by reading, extracting, and acting on patient information to ensure providers capture more referrals and reduce delays.