DME Order Clinical Reviewer

Solventum • San Antonio, TX

18h • Hybrid

About The Position

3M Health Care is now Solventum. At Solventum, we enable better, smarter, safer healthcare to improve lives. As a new company with a long legacy of creating breakthrough solutions for our customers’ toughest challenges, we pioneer game-changing innovations at the intersection of health, material and data science that change patients' lives for the better while enabling healthcare professionals to perform at their best. Because people, and their wellbeing, are at the heart of every scientific advancement we pursue. We partner closely with the brightest minds in healthcare to ensure that every solution we create melds the latest technology with compassion and empathy. Because at Solventum, we never stop solving for you. The Impact You’ll Make in this Role As a DME Order Clinical Reviewer , you will have the opportunity to tap into your curiosity and collaborate with some of the most innovative and diverse people around the world. Here, you will make an impact by:

Requirements

• 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.
• Must be legally authorized to work in country of employment without sponsorship for employment visa status (e.g., H1B status).

Nice To Haves

• 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.
• E xperience 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.

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.

Benefits

• Solventum offers many programs to help you live your best life, both physically and financially.
• To ensure competitive pay and benefits, Solventum regularly benchmarks with other companies that are comparable in size and scope.
• Medical, Dental & Vision, Health Savings Accounts, Health Care & Dependent Care Flexible Spending Accounts, Disability Benefits, Life Insurance, Voluntary Benefits, Paid Absences and Retirement Benefits

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED