Role Summary:
The Review Specialist serves on the front line of Shoreline’s compliance process. After AI completes an initial review of clinical documentation, Review Specialists validate compliance with Shoreline’s standards and ensure cases are defensible under Medicare and payer rules. Their work provides the final layer of human assurance before billing case approval.

Key Responsibilities:

• Review AI-flagged cases for compliance with LCD/NCD and Shoreline’s internal standards.
  
  

• Validate supporting documentation for completeness, accuracy, and defensibility.
  
  

• Identify errors or gaps and escalate findings to the Director of Client Services & Operations for approval.
  
  

• Provide structured feedback to Account Executives for client education.
  
  

• Document findings in compliance systems, ensuring full audit trails are maintained.
  
  

• Stay current on regulatory changes to ensure reviews reflect the latest compliance standards.