Hike Medical
DME Documentation Criteria Reviewer
San Francisco, CA
Sponsorship not specifiedDetected 34 days ago
RoboticsMedical Devices
About the role
- You review incoming patient documentation - physician notes, evaluations, prior authorization packets - against LCD criteria and payer policy, and identify exactly what is present, what is missing, and what can be obtained.
- You work inside our platform, and every review action you take becomes training data for the automation layer.
Responsibilities
- Build and maintain criteria checklists per code block, aligned with the Clinical Intelligence Lead's agent guides.
- Flag payer-specific deviations (e.g., UHC requirements that differ from Medicare) and document them in the policy library.
- Collaborate with the Protocol Specialist to update criteria sets when LCDs change.
- Detail-oriented, comfortable with structured checklists and building systematic review processes.
- AI-designed, robotically manufactured orthotic and prosthetic devices at scale, replacing a fragmented, manual industry that hasn't changed in decades.
- It owns the clinical and coding knowledge that powers every AI agent - producing agent guides per code block, setting evaluation standards, informing all compliance policies, and managing the human-in-the-loop team.
Requirements
- 3+ years reviewing DMEPOS documentation in a clinical, billing, or utilization management role.
- Experience with prior authorization at Medicare FFS and major commercial payers (UHC, Aetna, Cigna).
- Experience at a DMEPOS supplier, O&P company, or managed care organizatio
Nice to have
- Familiarity with HCPCS L-code ranges for orthotics and prosthetics preferred.
Benefits
- Read the full vision at bionics2040.com http://bionics2040.com.
- Support prior authorization packet assembly, ensuring each packet maps to the coverage criteria for the relevant payer.
- Solid understanding of CMS Local Coverage Determinations and Policy Articles for O&P and DME categories.
Company info
- the documents and workflows you build determine how fast we expand into new device categories.
- The DME Documentation Criteria Reviewer is the clinical analyst who turns medical necessity requirements into auditable, reviewable criteria sets.
- Review patient documentation for each device category against CMS LCD criteria and payer-specific requirements.
- Identify documentation gaps and generate structured deficiency notices to clinicians and prescribers.
- Audit HITL team reviews for criteria accuracy and consistency.
- What We Are Looking For
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