Medicare Documentation Specialist

This position is Hybrid and will require some in office days.

The anticipated pay range for this position is $24 hourly

Job Summary

The Medicare Documentation Specialist is responsible for reviewing patient medical records against strict Medicare guidelines to determine eligibility, ineligibility, or inability to determine due to missing or insufficient documentation. This role requires strong attention to detail, sound clinical judgment, and effective communication with both external clinic partners and internal sales teams to resolve documentation gaps and support accurate determinations.

Key Responsibilities

• Review and analyze patient chart notes and supporting documentation to assess eligibility in compliance with Medicare guidelines and company policies
• Accurately classify cases as eligible, ineligible, or unable to determine due to missing or unclear information
• Identify documentation gaps and proactively contact clinics via phone to clarify or obtain required information
• Communicate eligibility outcomes and documentation needs clearly and professionally to clinic staff
• Partner closely with internal sales representatives to provide timely updates, clarify requirements, and support case progression
• Maintain detailed, accurate records of reviews, outreach efforts, and determinations in internal systems
• Stay current on Medicare guidelines and internal processes; apply updates consistently in daily work
• Meet productivity, quality, and compliance expectations while maintaining a high level of accuracy
• Escalate complex or unclear cases appropriately and contribute to continuous process improvement

Qualifications

• Experience reviewing medical records, chart notes, or clinical documentation (Medicare, insurance, or eligibility review experience preferred)
• Strong understanding of medical documentation standards and regulatory guidelines (Medicare experience strongly preferred)
• Excellent attention to detail and ability to interpret nuanced clinical information
• Comfortable making outbound phone calls to clinics and having professional, sometimes corrective, conversations
• Strong communication and collaboration skills with both external partners and internal teams
• Ability to work independently, manage multiple cases, and meet deadlines in a structured environment
• Proficiency with electronic medical records (EMRs) and internal case management systems
• Experience working remote roles that require 8 hours of dedication

Preferred Skills

• Background in healthcare administration, nursing, coding, compliance, or utilization review
• Experience working cross-functionally with sales or business development teams
• Knowledge of audit, quality assurance, or compliance workflows
• Experience working with Microsoft Office tools such as Excel, Word, and Teams

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