DME Documentation & Criteria Reviewer

Tennr

2d • Onsite

About The Position

If you’ve worked in front-end intake, quality control, operations compliance, or audit review in the DME space, this is an opportunity to apply that experience in a new way. We’re growing our documentation and criteria review team to help ensure our platform accurately applies qualification logic based on Medicare, Medicaid, and commercial payer policies.
This is a detail-oriented, hands-on role focused on reviewing clinical documentation, assessing model-generated qualification outcomes, and identifying when decisions do or do not align with real-world payer standards.

Requirements

• You have hands-on DME experience in roles such as intake, documentation review, audits, or quality/compliance
• You are confident identifying when documentation meets or fails to meet payer requirements
• You are comfortable reviewing insurance coverage policies and applying them to real-world cases
• You are highly organized, detail-focused, and confident making policy-based decisions
• You work well independently and value open communication within a remote team setting

Nice To Haves

• 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 such as respiratory, mobility, and maternal health
• Experience with audits or appeals is a strong plus
• Familiarity with decision logic or rules-based platforms is helpful but not required

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

Benefits

• New, spacious Chelsea office
• Unlimited PTO
• 100% paid employee health benefit options
• Employer-funded 401(k) match
• Competitive parental leave
• Free lunch!
• Plus a pantry full of snacks.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed