Documentation Specialist
About The Position
The Documentation Specialist supports patient care and the revenue cycle by ensuring timely and accurate collection and management of patient documentation for compliant billing. The role works with physician offices, insurance providers, and internal teams to resolve documentation barriers that affect care and payment. Responsibilities include validating clinical documentation, managing eligibility materials and prior authorizations, reconciling documentation with outstanding charges, and maintaining accurate communication records. The specialist also provides backup customer service support and contributes to team productivity, quality, attendance, and continuous improvement standards.
Requirements
- High school diploma or equivalent work experience.
- One year of administrative experience; examples include insurance, billing, claims, call center, or financial services.
- Strong problem-solving skills and attention to detail.
- Strong verbal and written communication skills.
- Excellent customer service skills.
- Proficient computer and system skills.
- Ability to work in a fast-paced environment while multitasking.
Responsibilities
- Review, analyze, and validate clinical documentation for payer compliance and billing readiness.
- Collect and manage patient eligibility documents, including prescriptions, CMNs/LMNs, clinical notes, lab results, and prior authorizations.
- Resolve pending revenue by reconciling documentation with outstanding charges.
- Request and track prior authorizations, including coordination with state Medicaid programs.
- Identify recurring documentation issues or trends, and escalate them and educate internal teams and provider offices.
- Ensure compliance with Medicare, Medicaid, HIPAA, and private insurance regulations.
- Generate and manage electronic documentation requests to physicians and insurance companies.
- Communicate with physician offices and payers to obtain missing or incomplete documentation.
- Collaborate with sales, support, and customer service teams to support timely billing.
- Maintain and update physician databases to ensure accurate communication and document delivery.
- Provide backup support for customer service inquiries as needed.
- Meet productivity, quality, and attendance standards and contribute to a team-focused, continuous improvement culture.
- Perform other duties as assigned.
Benefits
- Comprehensive medical, dental, and vision coverage, eligible the first of the month following hire.
- 401(k) with company match.
- Paid time off plans, including six paid holidays.
- Employee Stock Purchase Plan.
- Paid Parental Bonding Leave.
- Short- and long-term disability insurance.
- Life and AD&D insurance.
- Flexible Spending Accounts (FSA) and Health Savings Accounts (HSA).
- CVS Minute Clinic and Teladoc access.
- Spousal Advantage Reimbursement Plan.
- Identity Theft Protection and Legal Plan.
- Competitive compensation and incentives.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
