Clinical Compliance Reviewer

Responsibilities

• In addition to conducting detailed reviews, the Clinical Compliance Reviewer actively supports initiatives to reduce the administrative and documentation burden on SLPs by improving report quality, clarity, and alignment with payer expectations.
• As a Clinical Documentation Reviewer, you will be responsible for:
• Clinical Documentation Review
• 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.
• Funding Process Support
• 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.
• SLP Support & Documentation Optimization
• 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.
• Policy & Criteria Management
• Assist 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
• Apply today!
• We believe in empowering individuals - including our own employees - to reach their full potential. So, if you want to change lives while growing your own career, we'd love to hear from you.
• Where we stand:
• We believe diversity not only enriches our workplace culture, but also gives us a strategic advantage. Working with people from a variety of backgrounds and perspectives helps us all become better communicators, better problem solvers, and better human beings. Our differences make us stronger.
• Tobii Dynavox values equality of opportunity, human dignity, and racial/ethnic and cultural diversity. Tobii Dynavox does

Benefits

Additional Information

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.

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