Clinical Criteria Reviewer – DME & Medicare (Remote) Fully Remote | $25–$34/hr | Contract-to-Hire | Equipment Provided Medix is hiring Clinical Criteria Reviewers for a healthcare technology organization focused on improving how prior authorization and medical necessity decisions are validated using structured documentation review and workflow tools. This role is ideal for professionals with experience in healthcare operations, documentation review, prior authorizations, appeals, denials, reimbursement, utilization review, case management, or Medicare-focused healthcare administration. You will review clinical documentation, evaluate payer coverage requirements, and validate determinations against Medicare, Medicaid, and commercial policies to ensure accuracy and documentation support. What You’ll Do

• Review documentation for completeness and accuracy
• Evaluate medical necessity and payer coverage criteria
• Identify documentation gaps and discrepancies
• Validate determinations against Medicare / commercial policies
• Document findings and support QA and process improvements
• Work within structured workflows and AI-assisted tools

What We’re Looking For

• 3+ years in healthcare operations, DME, reimbursement, prior auth, appeals, denials, utilization review, or claims review
• Experience applying payer policies (Medicare, Medicaid, commercial)
• Strong analytical and documentation review skills
• Experience with audits, compliance, or reimbursement workflows

Preferred Experience

• DME experience (oxygen, CPAP/BiPAP, mobility, orthotics)
• Medicare LCDs, HCPCS coding exposure
• Appeals, denials, or claims adjudication background
• Healthcare workflow or technology systems

Details

• Monday–Friday, 9–5 (40 hours)
• Fully Remote
• $25–$34/hr
• Benefits after 30 days
• Contract-to-hire

If you have experience in payer-driven documentation review, DME operations, or Medicare authorization workflows, we’d love to connect.