VGM Group, Inc.

At VGM Group, expertise becomes most valuable when it helps our clients navigate complexity with confidence. As a Clinical Advisor with The van Halem Group, you’ll serve as a trusted clinical and payer policy resource, reviewing patient medical documentation, interpreting coverage requirements, and translating your findings into clear, practical guidance for clients. The Clinical Advisor is a licensed nurse or respiratory therapist with experience in payer policies, medical review, benefit integrity, and client education who can help clients strengthen documentation, support billing readiness, and navigate the evolving requirements of Medicare, Medicaid, commercial payers, and DMEPOS.
Why this role matters
Clinical Advisors help clients navigate complex payer requirements, strengthen clinical documentation, and make informed decisions which in turn supports better outcomes for both businesses and patients. Your practical guidance and subject matter expertise will strengthen the partnerships we greatly value at VGM Group.
Position Summary:
The Clinical Advisor for The van Halem Group – A Division of VGM Group, Inc. serves as a clinical and payer policy resource for clients by reviewing patient medical files, determining whether Medicare, Medicaid, commercial payer, and/or DMEPOS coverage criteria have been met, and providing clear education, documentation feedback, issue summaries, and recommendations. Employees must be a licensed nurse or respiratory therapist with experience in payer policies, medical review, benefit integrity, and client education; specific knowledge of durable medical equipment, prosthetics, orthotics, and supplies is preferred.
At VGM Group, we are 100% employee owned.
Click here to view more about VGM Group!
Reporting Accountability:
Senior Principal Clinical Advisor
Working Location:
Remote
Work Hours Classification:
8am-5pm, Monday-Friday (Additional hours as necessary to accomplish goals and deliverables of the position)
What You'll Do
The Clinical Advisor is responsible for evaluating patient medical files against applicable payer coverage criteria and translating findings into practical, informative guidance that supports client compliance, billing readiness, and education.
<ul>
<li>Review clients’ patient medical files to determine whether applicable payer coverage criteria are met prior to billing insurance for claim payment</li>
<li>Apply knowledge of contract-specific, payer-specific, and clinical documentation guidelines when advising clients</li>
<li>Interpret healthcare insurance guidelines, rules, regulations, and coverage requirements to support accurate client recommendations</li>
<li>Excellent verbal and written communication skills</li>
<li>Serve as a clinical advisor by answering questions from staff and clients regarding documentation, coverage requirements, and review findings</li>
<li>Follows strict HIPAA confidentiality guidelines</li>
<li>Manage cases and input medical decisions in the Company’s case management system</li>
<li>Confirm orders are set up with accurate codes, quantities, and supporting documentation based on applicable payer requirements</li>
<li>Identify client training needs based on clinical review trends, documentation gaps, payer policy updates, and recurring questions</li>
<li>Develop training, education, and advisory materials that help clients understand coverage policies, documentation expectations, and compliance considerations</li>
<li>Deliver client education and advisory support through in-person seminars, webinars, written materials, PowerPoint presentations, and other appropriate methods</li>
<li>Any other duties as deemed appropriate by the management</li>
</ul>
What Will Make You Successful
Must hold a valid registered nurse or respiratory therapist license (RN or RT) and relevant experience in reviewing documentation for DMEPOS claims.
<ul>
<li>Proficient in payer policies and medical review or benefit integrity</li>
<li>Additional certification as a Certified Professional Coder is preferred, but not required</li>
<li>Excellent computer skills including Excel, Word, and other Microsoft Office products</li>
<li>Excellent communication skills, including oral and written communication</li>
<li>High degree of organization and administrative process skills including great attention to detail</li>
<li>Capacity to work independently with minimal direction</li>
<li>Evidence of learning quickly and ability to build on existing business foundations</li>
<li>Ability to administer and coordinate across multiple tasks and deadlines</li>
<li>Advanced professionalism and ability to maintain strict confidentiality of company and employee information</li>
<li>Ability to work in a fast-paced environment with multiple priorities</li>
</ul>
Physical Requirements
<ul>
<li>Sitting for long amounts of time</li>
<li>Using technology efficiently such as computers, phones, misc. office equipment, and software</li>
<li>Travel as needed</li>
</ul>
Learn More About VGM Group, Inc.
VGM Group, Inc. is a 100% employee-owned company providing professional services to thousands of businesses across North America. Services include group purchasing, commercial insurance, management of post-acute healthcare offerings, distribution direct to patient homes, marketing and more. VGM Group, Inc. has been named the Top Workplace in Iowa on multiple occasions and is proud of its role in the communities in which it serves. For more information visit <a href="http://www.vgmgroup.com" rel="nofollow noopener" target="_blank">www.vgmgroup.com</a>.
This job description reflects the general duties of the job but is not a detailed description of all duties which may be inherent to the position. Reasonably related additional duties may be assigned to the individual Associate.
VGM Group, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Clinical Advisor (RN, RT)

Clinical Advisor (RN, RT)

This job is no longer available

Talents

Recruiters

About