Medical Reviewer, Surgical Dressings

Verse Medical Inc.

Job Overview

Location

Remote

Job Type

Full-time

Full Job Description

📋 Description

• As a Medical Reviewer for Surgical Dressings at Verse Medical Inc., you will play a critical role in ensuring that at-home surgical dressing orders comply with CMS regulations, MAC and UPIC policies, and billing standards—directly impacting patient access to high-quality, hospital-grade care.
• Your day-to-day responsibilities will include interpreting LCD L33831 and related policy articles into actionable clinical and billing rules, building two-gate pre-bill QA processes for clinical completeness and billing correctness, leading UPIC/MAC ADR responses (both pre- and post-pay), creating training modules for customer-facing teams and billers, and defining and tracking key performance metrics such as denial rates, appeal win rates, and ADR turnaround times.
• You will join a mission-driven, Series C-backed healthcare technology company (supported by General Catalyst, SignalFire, and Sapphire Ventures) that is modernizing the fragmented home care infrastructure by connecting providers, payors, and patients through innovative software solutions.
• In this role, you will deepen your expertise in DME policy interpretation, gain hands-on experience shaping compliance workflows at scale, develop leadership skills in training and process design, and contribute to measurable improvements in claim accuracy and appeals outcomes—positioning you for growth in healthcare operations, policy, or compliance leadership.

🎯 Requirements

• 3-5+ years of medical review experience at a UPIC or MAC (e.g., Safeguard Services, Qlarant, CoventBridge; Noridian, CGS, NGS, WPS, Novitas, Palmetto)
• Hands-on adjudication experience with surgical dressings including A6021 collagen, A6196–A6199 alginate/fiber-gelling, A6209–A6215 foam, A6212–A6214 bordered foam, A6216–A6221 gauze, and A6257–A6259 film
• Expertise in 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)
• Strong policy-anchored writing skills, ability to work calmly under deadlines, and disciplined handling of PHI

🏖️ Benefits

• Up to $105,000 base salary (based on experience and expertise)
• 100% employer-paid health insurance premiums, plus access to high-quality dental and vision plans for employee and dependents
• 401(k) plan available for retirement savings (company does not currently offer a match)
• Opportunities for rapid career advancement in a high-growth, mission-driven company at a major inflection point
• Fully remote work environment

Skills & Technologies

Fiber

Remote

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Verse Medical Inc.

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About Verse Medical Inc.

Verse Medical Inc. operates a digital platform that connects healthcare providers with medical suppliers for purchasing surgical and clinical supplies. The company streamlines procurement through a cloud-based marketplace, offering real-time pricing, inventory visibility, and analytics tools to reduce costs and improve supply chain efficiency for hospitals and surgery centers across the United States.

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