• We believe that diverse experiences and backgrounds lead to better solutions. While we have an idea of what will help someone succeed in this role, we are open to being convinced by your unique story and skills. If you believe you can achieve the outcomes above, we encourage you to apply.
• 3-5+ years medical‑review experience at a UPIC or MAC (e.g., Safeguard Services, Qlarant, CoventBridge; Noridian, CGS, NGS, WPS, Novitas, Palmetto).
• Hands‑on adjudication of surgical dressings (A6021 collagen; A6196–A6199 alginate/fiber‑gelling; A6209–A6215 foam; A6212–A6214 bordered foam; A6216–A6221 gauze; A6257–A6259 film).
• Expert with proof‑of‑delivery standards, SWO requirements, frequency/sizing rules, and common denial rationales (e.g., two‑cover stacking, over‑frequency without rationale, DOS/POD mismatch). Most of our interview process is focused on your practical experience with the coverage guidelines.
• Crisp, policy‑anchored writing; calm under deadline; disciplined with PHI.
• OUR PLEDGE FOR AN EQUITABLE FUTURE