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Troy Wohlgemuth

@troywohlgemuth

Senior medical documentation reviewer specializing in PIP claims, medical necessity, and injury progression.

United States
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What I'm looking for

I’m looking to continue reviewing PIP and injury claim documentation—focusing on medical necessity, injury causation, and treatment progression—while meeting payer standards. I want a role where clear clinical narratives and compliant coding directly support accurate claim decisions.

I’m a licensed Doctor of Chiropractic and former Clinical Director with 25 years of experience evaluating musculoskeletal injuries tied to auto accidents, personal injury, and workers’ compensation. I review medical records, diagnostic imaging (X-ray, MRI, NCV studies), and clinical documentation to support insurance-related decisions.

In my work, I assess injury causation, symptom progression, and treatment necessity, ensuring documentation stays consistent and compliant with payer requirements over time. I also handle CPT and ICD-10 coding in billing processes and support utilization review and prior authorization requirements.

I regularly collaborate with insurance carriers, attorneys, case managers, and third-party administrators by preparing narrative reports and responding to documentation requests. When I find gaps or inconsistencies, I identify what needs clarification so claims are supported accurately from intake through case monitoring and outcome tracking.

Experience

Work history, roles, and key accomplishments

HP

Clinical Director, D.C.

Healthview Rehabilitation Center PSC

Jan 2000 - Jan 2025 (25 years)

Served as Doctor of Chiropractic and Clinical Director, evaluating auto injury, personal injury, and workers’ compensation cases by reviewing medical records, imaging, and treatment progression to support injury causation and medical necessity decisions for PIP and payer reviews. Produced CPT/ICD-10 coding, utilization review documentation, and narrative clinical reports for insurance carriers, at

Education

Degrees, certifications, and relevant coursework

NU

Northwestern Health Sciences University

Doctor of Chiropractic, Chiropractic

Earned a Doctor of Chiropractic (D.C.) degree from Northwestern Health Sciences University in 1999.

Northwestern Health Sciences University logoNU

Northwestern Health Sciences University

Bachelor of Science, Human Biology

Earned a Bachelor of Science degree in Human Biology from Northwestern Health Sciences University in 1996.

Tech stack

Software and tools used professionally

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