• Provide operational support to the Medical Review Manager and the Medical Review Staff in managing production related to claims determinations and review • Serve as a critical component in meeting our mission of providing excellent services to our clients • Review and analyze sampled Medicare claims using associated medical records • Make payment determinations based on coverage, coding, utilization of services and practice guidelines • Perform third-level Medical Review in determination of claims payment review • Conduct in-depth claims analysis utilizing ICD-9-CM, ICD-10-CM, CPT-4, and HCPCS Level II coding principles • Conducts medical record audits to determine the medical necessity and/or appropriateness of medical treatment using CMS and other national guidelines • Assist with training to integral staff for special studies as well as regular project claims review

Role Description You’ll help shape AI used by millions every day. As a Digital Ads Quality Analyst, you’ll review online ads and provide real human feedback that makes digital advertising smarter, safer, and more relevant for users in Türkiye and across Europe — all from home, on your own schedule. - Evaluate how well ads match what users in Türkiye and German‑speaking markets are searching for - Assess ad quality, language accuracy, and cultural relevance - Provide clear, honest feedback to improve ad performance - Contribute your human perspective to AI training - Work at your own pace, task by task Qualifications - Fluent in German and English (professional level) - Living in Türkiye (local cultural knowledge is essential) - Regular experience using social media and browsing the web - Reliable internet connection and a computer with antivirus - A smartphone (Android 4.1+ or iOS 8+) - Strong attention to detail and good communication skills - An English CV ready to upload Requirements - Language Check — Show your English and German skills - Knowledge Exam — Open‑book, with study materials provided - ID Verification — Standard security step Benefits - Support Designed for Remote Work - 24/7 confidential access to emotional, psychological, and practical support - 90‑day aftercare after leaving the program - Free Headspace Premium for mindfulness, focus, and better sleep - Fast support with responses within 24 hours - Proactive protection against stressful content - Regular wellbeing resources and training - Join 1M+ human raters improving AI for leading global technology companies - Be part of a diverse international community of digital professionals - See your work influence technology used worldwide - 100% remote — work from anywhere in Türkiye - Fully flexible hours (long‑term project) - No previous professional experience required

Role Description This position is responsible for performing accurate and timely medical review of regular business, state of Texas and national accounts claims suspended for medical necessity, contract interpretation, and pricing; and to initiate and/or respond to correspondence from providers or members concerning medical determinations. Qualifications - Registered Nurse with current, active, unrestricted Registered Nurse (RN) license in the state of operations (or reciprocity). For compact licensee changing permanent residence to state of operations, must obtain active, unrestricted RN licensure in the state of operations within 90 days of hire. - 3 years clinical experience. - Verbal and written communications skills. - Analytical and decision-making skills. - Customer Service. Requirements - Prior MRU experience (preferred). - NICU experience (preferred). Benefits - Health and wellness benefits. - 401(k) savings plan. - Pension plan. - Paid time off. - Paid parental leave. - Disability insurance. - Supplemental life insurance. - Employee assistance program. - Paid holidays. - Tuition reimbursement. - Other incentives. Company Description At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Role Description This isn't just a job; it's a chance to build something that matters. As Medical Reviewer, you'll be shaping the future of at-home care. You'll be a key part of the team, working to ensure each surgical dressing order is fully compliant with every CMS regulation, including regulation/policies as they are applied by MACs & UPICs. You’ll translate LCDs/Articles and MAC playbooks into checklists, fix packet defects pre-bill, and run our ADRs/appeals processes. Your Contributions - Policy → Practice - Interpret and operationalize LCD L33831 + Policy Article for surgical dressings; publish practical rules (when covered, limits, documentation phrases). - 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. Qualifications - 3-5+ years medical-review experience at a UPIC or MAC (e.g., Safeguard Services, Qlarant, CoventBridge; Noridian, CGS, NGS, WPS, Novitas, Palmetto). - 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. We can only achieve this if our own team reflects the diversity of the patients we serve. We are committed to building a workplace where everyone feels a sense of belonging, where their contributions are valued, and where they can do their best work. We embrace diversity of all kinds: race, gender, age, religion, identity, experience. We are actively working to build a more inclusive and equitable world, starting from within our own walls. We are an equal opportunity employer. We are also committed to providing a positive and accessible interview experience. If you require any accommodations to participate in our process, please contact us at recruiting@versemedical.com.