Clinical Compliance Reviewer
Why Join Us
We’re on a mission to empower people with disabilities to do what they once did or never thought possible. As the world-leader in assistive communication solutions, we empower our customers to express themselves, connect with the world, and live richer lives. At Tobii Dynavox, you can grow your career within a dynamic, global company that has a clear, impactful purpose - with the flexibility to also do what truly matters to you outside of work. What’s more, you’ll be part of a work culture where collaboration is the norm and individuality is welcomed. As a member of our team, you’ll have the power to make it happen. You’ll solve challenges, deliver solutions and develop new, efficient processes that make a direct impact on our customers’ lives.
About the Role
The Clinical Compliance Reviewer is responsible for ensuring that clinical documentation—particularly Speech-Language Pathology (SLP) evaluations—meets payer-specific insurance coverage criteria to support successful funding outcomes. This role serves as a critical bridge between clinical documentation and funding requirements, providing expert review, feedback, and guidance to reduce the risk of denials and 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.
- Aid 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.
Requirements
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