USA-Documentation Specialist II (Administrative)

Spectraforce Technologies; Cambridge (MA); Remote; USD 30,000 - 47,000; Full time

Job summary

Spectraforce Technologies, Inc. is seeking a Documentation Specialist II (Administrative) to verify insurance coverage and benefits, and to maintain accurate case documentation in the CRM from a 100% remote setting.

The role emphasizes handling sensitive patient data, coordinating with providers and Case Management, and ensuring timely, accurate information to support patient care and approvals under HIPAA guidelines.

Qualifications

• AA Degree required; Bachelor's degree preferred.
• Experience with health insurance reimbursement or relevant work preferred.
• Ability to handle sensitive information (PII/PHI) with discretion.
• Strong communication, problem-solving, and negotiation skills.
• Ability to work in a fast-paced environment with high-volume tasks.

Responsibilities

• Verify insurance coverage and benefits, contacting providers as needed.
• Research prior authorization processes and share requirements with Case Management.
• Follow up with payers on authorization status for enrolled patients.
• Re-verify benefits and address denials and barriers to continued treatment.
• Document interactions and data in the CRM with HIPAA compliance.
• Coordinate with Reimbursement Support to distribute tasks efficiently.
• Maintain up-to-date knowledge of billing, coding, and payer trends.
• Provide quality phone support to inbound callers.
• Assist in resolution of copay claim issues under Copay Assistance.

Skills

Communication

Problem-solving

Negotiation

Attention to detail

Education

AA Degree

Bachelor's Degree

Tools

Salesforce CRM

MS Word

MS Excel

MS PowerPoint

Job description

Position Title: Documentation Specialist II (Administrative)
Work Location: 100% Remote
Assignment Duration: 6 Months
Work Schedule: Working hours may vary based on business needs and team coverage
Work Arrangement: Remote

Position Summary

Verify current insurance coverage policies and benefit details through direct contact with medical insurance providers and ensure prompt return of accurate information to facilitate the initiation and ongoing continuity of treatment. Research and identify insurance company prior authorization processes and provide necessary documents and requirements to Case Management team members.

Key Responsibilities

• Verify current insurance coverage policies and benefit details through direct contact with medical insurance providers and ensure prompt return of accurate information to facilitate the initiation and ongoing continuity of treatment
• Research and identify insurance company prior authorization processes and provide necessary documents and requirements to Case Management team members
• Follow up with payers to determine status of prior authorizations for enrolled patients
• Re-verify insurance benefits as needed for the patients
• Research denied and incomplete claims to address potential barriers impacting access to continued treatment
• Track and follow up on in-process claims and denials to the point of resolution providing ongoing cross functional updates
• Assist Patient Support Services team in the resolution of copay claim issues related to our organization Copay Assistance Program
• Process new enrollment forms
• Provide quality phone customer service to inbound callers
• Coordinate with the Reimbursement Support Specialist team to efficiently assign and distribute tasks from the shared work queue
• Maintain up-to-date knowledge of the reimbursement process, billing/coding guidelines, dose calculations, healthcare policy, insurance plans, payer trends, financial assistance programs, and related resources
• Complete daily documentation of all interactions and input accurate data on each individual cases, their insurance, coverage approvals and ongoing coverage requirements in CRM Database while maintaining compliance with HIPAA and other regulating bodies as required
• Establish proficiency and full understanding of our organization Patient Support Services Customer Relationship database including undertaking of data elements, case statuses and outcomes, and documentation requirements
• Ensure full compliance with our organization policies, procedures, and guidelines

Qualification & Experience

• AA Degree required, Bachelors Degree preferred
• 1-3 years' experience in health insurance reimbursement or equivalent applicable work experience preferred
• Demonstrated ability to handle sensitive and confidential information, including patient personal data (PII/PHI), with discretion and care at all times
• Effective communication, problem-solving and negotiation skills
• Ability to think critically and problem solve to address customer needs
• Ability to work in a fast-paced environment
• Experience working in a high-volume patient services program preferred
• Experience with Salesforce CRM preferred
• Proficient with MS Word, MS Excel, and MS PowerPoint