DMT Clinical Records & Audit Support Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Assist the Denials Management Team in organizing and compiling records for Medicaid audits, requests for Part B physician services, and designated reviews.

• Examine audit and documentation request letters to ascertain the requested records, date ranges, claim details, and submission criteria.

• Find, gather, structure, and compile clinical, billing, administrative, and supplementary documentation from electronic medical records and authorized systems.

• Identify pertinent documentation while recognizing gaps, inconsistencies, missing signatures, or incomplete records for further escalation.

• Arrange records into approved packets through indexing, bookmarking, pagination, file naming, and conducting a final quality review.

• Compare the compiled records to requests and internal checklists before forwarding packets for review.

• Communicate with agency staff, physician services teams, clinical personnel, and DMT members regarding outstanding records, inquiries, and deadlines.

• Maintain audit activities, request statuses, notes, and supporting documentation within DMT applications, Excel, Smartsheet, and designated folders.

• Locate and reference guidelines from Medicare, Medicaid, CMS, payers, and state regulations.

• Safeguard confidential information and adhere to HIPAA, company policies, payer, and regulatory requirements.

• Engage in cross-training, education, and initiatives for process improvement.

⛳️ Requirements

• A current Licensed Practical Nurse (LPN) license is preferred; candidates with significant clinical knowledge or relevant healthcare experience may also be considered.

• Experience in Medicaid Home Health, Hospice, home care, or Part B physician services is strongly preferred.

• Clinical knowledge of standard medical record components, plans of care, orders, visit or procedure documentation, and related billing documentation.

• Experience with healthcare audits, medical record requests, additional documentation requests, payer reviews, or record compilation is preferred.

• Ability to research and reference Medicare, Medicaid, CMS, payer, and relevant state regulatory guidelines.

• Experience navigating electronic medical records and healthcare information systems.

• Proficiency with PDF editing and document assembly tools.

• Competence in Microsoft Office, including Excel and Outlook.

• Strong attention to detail and the capacity to follow precise request language, checklists, naming conventions, and workflows.

• Ability to organize, prioritize, and manage multiple assignments in a fast-paced environment.

• Initiative in researching and resolving routine issues while escalating clinical, regulatory, or documentation concerns as needed.

• Excellent written and verbal communication skills.

• Capability to work independently and collaboratively as part of a team, adapt to changing requirements, accept feedback, and maintain confidentiality.

🏝️ Benefits

• Genuine work-life balance.

• Comprehensive benefits package (medical, dental, vision, 401(k) with match).

• Paid time off.

• Holiday pay.

• Opportunities for professional development.

• Supportive and collaborative team culture.