Specialist, Qualifications

Synapse Health • Easley, SC

15d • $17 - $21 • Onsite

About The Position

As a Specialist, Qualifications within the Customer Connect Center (CCC) at Synapse Health, you serve as a critical gatekeeper of clinical accuracy, documentation quality, and regulatory compliance. You are responsible for reviewing, validating, and maintaining medical documentation to ensure orders meet payer, clinical, and operational requirements before fulfillment.
In this role, you regularly interact with physician offices and, at times, prescribing providers to obtain, clarify, and validate clinical information. Your ability to efficiently interpret medical records, apply insurance and payer guidelines, and identify documentation gaps is essential to ensuring clean, timely, and compliant DME order processing.
This position is fully onsite in the Synapse Health office in Easley, SC 29640.

Requirements

• 2+ years of recent experience in healthcare equipment or durable medical equipment (DME), including roles in qualifications, customer service, logistics, transitions, or related functions.
• Strong proficiency in Microsoft Office applications and the ability to quickly learn department- and role-specific systems.
• Excellent organizational skills with the ability to manage high volumes of documentation accurately and efficiently.
• Effective verbal and written communication skills, including collaboration with provider offices and internal teams.
• Strong analytical and problem-solving abilities to identify documentation gaps, interpret guidelines, and resolve issues.
• High attention to detail and a strong commitment to accuracy and compliance.
• Must live within a commutable distance to Easley, SC 29640 as this is a fully onsite position.

Nice To Haves

• Customer-Focused: Builds strong relationships and delivers patient- and provider-centered solutions.
• Effective Communicator: Clearly conveys documentation requirements and expectations across multiple audiences.
• Nimble Learner: Quickly adapts to changing payer guidelines, workflows, and systems.
• Action-Oriented: Approaches challenges with urgency, accountability, and follow-through.
• Process-Minded: Identifies opportunities to improve documentation quality and operational efficiency.
• Tech-Savvy: Comfortable learning and adopting new tools, platforms, and healthcare technologies.

Responsibilities

• Manage incoming referrals, ensuring all required clinical and supporting documentation is obtained within established timelines.
• Review, record, and maintain all incoming orders and documentation within electronic medical records and document management systems.
• Coordinate and process precertification and recertification requirements for Durable Medical Equipment (DME).
• Apply payer and insurance provider guidelines to determine documentation requirements and authorization eligibility.
• Perform routine audits of patient medical files to ensure accuracy, completeness, and compliance with internal standards and regulatory requirements.
• Identify documentation discrepancies, errors, or missing information and work directly with referral sources and provider offices to obtain clarification or corrections.
• Prepare, convert, and maintain paper and electronic documentation in accordance with organizational document storage and retention policies.
• Maintain compliance with policies and procedures related to documenting, storing, and retrieving medical, legal, and insurance information in accordance with federal, state, and local regulations.
• Respond to inquiries related to patient charts, documentation status, and qualification requirements.
• Run insurance cost estimates, collect patient responsibility information, and explain rental versus purchase options when applicable.
• Present and distribute provider documentation and product education materials to patients, coordinating electronic signature collection as required.
• Support educational efforts by contributing to instructional materials and assisting with training for healthcare personnel, as needed.
• Act with advocacy and urgency to ensure the needs of patients, prescribers, and referral sources are met efficiently.
• Deliver a high-quality patient experience while meeting established performance metrics, including productivity, documentation accuracy, call quality, member satisfaction, first call resolution, and attendance.
• Maintain strict confidentiality of patient health information and adhere to HIPAA and organizational privacy standards.
• Partner with program leadership and senior team members on escalated cases or complex qualification questions.
• Participate in an on-call rotation to support after-hours member requests.
• Perform additional duties as assigned to support operational and team objectives.

Benefits

• Professional growth opportunities with compelling career paths
• Healthy work-life balance supported by generous paid time off (PTO)
• Comprehensive benefits package, including medical, dental, vision, STD & LTD insurance for full-time team members
• 401(k) savings plan with employer matching contributions

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 11-50 employees