Tennr is looking for a DME Documentation & Criteria Reviewer to ensure our platform accurately applies qualification logic based on real-world Medicare, Medicaid, and commercial payer standards. This detail-oriented role is central to identifying discrepancies and improving the system that helps reduce patient delays in the U.S. healthcare system.

What You'll Do

Flag incorrect determinations, including false positives, false negatives, and unclear logic, with structured feedback.
Compare clinical documentation against Medicare, Medicaid, and commercial payer coverage policies.
Analyze source materials like insurance policies and LCDs to help validate qualification logic.
Work closely with internal teams to refine prompting logic and improve documentation review standards.
Maintain clear documentation of findings and contribute to process improvements.

What We're Looking For

You have hands-on DME experience in roles such as intake, documentation review, audits, or quality/compliance.
You are confident identifying when documentation meets or fails to meet payer requirements.
You are comfortable reviewing insurance coverage policies and applying them to real-world cases.
You are highly organized, detail-focused, and confident making policy-based decisions.
You work well independently and value open communication within a remote team setting.

Nice to Have

4+ years working in DME, ideally in documentation review, intake, audits, or compliance roles.
Familiarity with Medicare, Medicaid, and commercial payer guidelines for DME.
Understanding of HCPCS codes and common DME categories such as respiratory, mobility, and maternal health.
Experience with audits or appeals is a strong plus.
Familiarity with decision logic or rules-based platforms is helpful but not required.