Medical Review Nurse

OUR MISSION: HOSPITAL-QUALITY CARE, EVERYWHERE. The healthcare industry still relies on faxes and phone tags to coordinate critical care for patients at home. We think patients and the clinicians who serve them deserve better than a system stuck in 1995. Verse Medical is building the modern software infrastructure to make it happen. We're a well-funded Series C company (backed by General Catalyst, SignalFire, and Sapphire Ventures) on a mission to heal a fragmented system. Our platform connects the dots between providers, payors, and patients, ensuring people get the high-quality care they need, reliably and right where they live. We’re growing fast and looking for people who are driven by this mission to join us!

Our Values

• We are transparent, upfront and direct. We operate with honesty and clarity. We share information openly, the good and the bad, and believe that direct, respectful feedback is the foundation of trust and progress.
• We value speed of iteration.

• We give 110% effort, 30% of the time. We are passionate about our mission, and there are moments that require us to go the extra mile.

• We empathize with customers to a fault. When our users face a problem, we own it. Instead of asking them to change, we ask ourselves, "How can we make this better?" We believe true innovation comes from deep empathy and a relentless focus on solving the real-world challenges of healthcare.

• Stand up “go/no‑go” criteria for collagen, alginate/fiber‑gelling, foam, film, hydrocolloid; codify A‑modifier (wound count) usage, KX/GA/GZ/EY, sizing, quantity/frequency math.
• Pre‑Bill Controls - Build a 2‑gate QA (1: clinical completeness; 2: billing correctness) and pilot it on all surgical‑dressing claims.
• Create/upgrade templates for various outreach.
• Audit & Appeals - Lead UPIC/MAC ADR responses (pre‑ and post‑pay).
• Coach internal billing team; establish a reusable appeals library with policy citations and exemplars.
• Enablement & Analytics - Train customer-facing team members (30‑min modules) and billers on the specific documentation that satisfies the LCD.
• Define and track metrics: initial denial %, appeal win %, ADR turnaround, % packets with signed POD, top‑defect Pareto.

• Hands‑on adjudication of surgical dressings (A6021 collagen; A6196–A6199 alginate/fiber‑gelling; A6209–A6215 foam; A6212–A6214 bordered foam; A6216–A6221 gauze; A6257–A6259 film).
• Expert with proof‑of‑delivery standards, SWO requirements, frequency/sizing rules, and common denial rationales (e.g., two‑cover stacking, over‑frequency without rationale, DOS/POD mismatch).

• Crisp, policy‑anchored writing; calm under deadline; disciplined with PHI. OUR PLEDGE FOR AN EQUITABLE FUTURE At Verse Medical, our mission is to deliver equitable, hospital-quality care to everyone, regardless of their background or where they live.

• Highlight any direct experience with CMS LCDs or MAC/UPIC appeals in your résumé; concrete examples beat generic claims.
• Prepare a short case study that shows how you built a QA workflow or reduced claim denials in a previous role; be ready to discuss metrics.
• Familiarize yourself with Verse Medical’s platform basics (publicly available demos or blog posts) so you can speak to integration ideas.
• During interviews, demonstrate empathy by walking through a patient‑centric scenario and explaining how your policy work improves outcomes.
• Ask about the two‑gate QA system’s current state; showing curiosity signals you’re ready to iterate from day one.
• If salary isn’t disclosed, research comparable remote medical‑review roles and be prepared with a reasoned range for negotiation.
• Watch for vague promises about “flexible hours” without clear expectations around core overlap times; clarify communication norms early.