Qualifications for a Medical Review Consultant
Are you a seasoned hospice leader who excels at navigating complex Medicare oversight and defending clinical integrity? We are looking for an expert consultant to help providers master regulatory scrutiny, safeguard reimbursement, and elevate compliance.
What You Bring:
Hospice Leadership & Clinical Insight: Extensive operational leadership with a deep command of Medicare CoPs, Conditions of Payment, LCDs, standardized assessments, and terminal eligibility.
Full-Cycle Audit Defense: Proven track record managing ADRs, TPE, UPIC, SMRC, RAC audits, and ALJ hearings—from chart audits and submission prep to persuasive appeal drafting and hearing defense.
Provider Coaching & Documentation Integrity: Sharp eye for clinical documentation vulnerabilities paired with the ability to educate interdisciplinary teams on proactive compliance.
Current & Emerging Regulatory Acumen: Strong working knowledge of high-impact CMS oversight trends, including 2026 payment suspension initiatives, state-level PPEO enforcement, and CY 2027 Hospice Final Rule changes (such as SSVI metrics and Election Statement Addenda).
