Medical Reviewer (Durable Medical Equipment Specialist) - Remote CA

About the role

Gainwell Technologies is seeking a Medical Reviewer (Durable Medical Equipment Specialist) to provide subject-matter expertise supporting Medical Review Services for California healthcare programs. In this role, you will review durable medical equipment (DME) claims, Treatment Authorization Requests (TARs), prescriptions, and supporting medical documentation to help ensure equipment and services meet applicable medical necessity, coverage, billing, and program requirements.

Responsibilities

• Review DME-related claims, Treatment Authorization Requests (TARs), prescriptions, and supporting medical documentation.
• Evaluate requests for durable medical equipment based on applicable medical policies, coverage requirements, and program guidelines.
• Review documentation supporting the medical necessity and appropriate use of durable medical equipment.
• Apply knowledge of DME products, supplies, billing practices, and healthcare reimbursement when completing reviews.
• Support claim adjudication and authorization activities involving DME.
• Document review findings, decisions, and supporting rationale accurately and timely.
• Identify documentation, billing, or coverage issues requiring additional review or clarification.
• Collaborate with clinicians, providers, operations teams, and other Medical Review Services professionals.
• Maintain knowledge of applicable DME policies, coverage requirements, billing practices, and regulatory guidelines.
• Meet established quality, accuracy, productivity, and turnaround-time expectations.

Requirements

• Minimum of three (3) years of professional experience working with Durable Medical Equipment (DME).
• Strong knowledge of DME products, equipment, supplies, and their uses.
• Management of a DME business and/or understanding of healthcare billing preferred.
• Ability to interpret medical documentation, prescriptions, claims, and supporting information.
• Strong analytical, documentation, written, and verbal communication skills.
• Ability to work independently while collaborating effectively with clinical, operational, and cross-functional teams.

Schedule

Full-time, remote position with a Monday through Friday work schedule.

Pay

The pay range for this position is [[salaryMin]] - [[salaryMid]] per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.

Benefits

• Generous, flexible vacation policy.
• 401(k) employer match.
• Comprehensive health benefits.
• Educational assistance.
• Leadership and technical development academies to help build your skills and capabilities.