Solventum · 13 hours ago
DME Order Clinical Reviewer
US, Texas, San Antonio
Full-time
Hybrid
Entry, Mid Level
$50K/yr - $69K/yr
2+ years expSolventum is a new healthcare company focused on improving lives through innovative solutions. The DME Order Clinical Reviewer will analyze DME orders, review clinical documentation, and support order management to ensure compliance with medical criteria.
Medical Device
No H1B
Responsibilities
Analyzing and prioritizing work based on department and customer needs
Interpreting third-party payer medical criteria and applying criteria accurately to DME orders
Conducting in-depth reviews of clinical documentation (e.g., medical records, operative reports, H&P, progress notes) against billing/coverage requirements
Communicating clearly and proactively with internal partners regarding missing or required documentation to medically qualify an order
Supporting the Order Management organization by educating non-clinical staff on clinical criteria and documentation needs to enable timely order release
Following and enforcing all company policies, procedures, and compliance standards
Meeting weekly/monthly/quarterly production and quality expectations aligned to departmental priorities
Performing work that requires repetitive keyboarding 95%+ of the time
Qualification
Required
High School Diploma/GED or higher (completed and verified prior to start) from an accredited institution
Two (2) years of clinical healthcare experience
Current nurse license (LVN/LPN/RN) in good standing
Working knowledge of compliance standards, including HIPAA and other regulations governing patient privacy and healthcare billing practices
Preferred
Experience with Microsoft Office applications including Word, Excel, and email
Strong time management and organizational skills, including the ability to prioritize tasks, manage workload efficiently, and meet deadlines
Experience with understanding payor criteria and guidelines
Proficiency navigating internal systems and platforms (e.g., Delair, HERO, FileNet P8, Medicare Recert, FileNet P8 Workbasket, NICE for internal candidates only)
Demonstrated ability to work effectively with employees and external contacts while maintaining a positive, service-oriented approach
Strong problem-solving skills with the ability to work both independently and collaboratively
Demonstrated ability to multi-task and adapt in a fast-paced, changing environment
Proven ability to maintain confidentiality, exercise discretion, and apply sound business judgment
Benefits
Medical
Dental & Vision
Health Savings Accounts
Health Care & Dependent Care Flexible Spending Accounts
Disability Benefits
Life Insurance
Voluntary Benefits
Paid Absences
Retirement Benefits
Company
Solventum
At Solventum, we enable better, smarter, safer healthcare to improve lives. We never stop solving for you.
10001+ employees
Funding
Current Stage
Late StageCompany data provided by crunchbase