Payor Process and Documentation Specialist

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

📋 Description

• Develop and maintain clear, standardized documentation outlining payor requirements, submission processes, and authorization workflows.

• Create and enhance checklists for prior authorization and benefit verification submissions across various payors, ensuring uniformity in format and terminology.

• Annotate and categorize source materials (payor policies, portal captures, requirement documents) with structured, consistent labels for internal reference and system utilization.

• Edit and standardize documentation prepared by others to ensure all materials adhere to a consistent style, structure, and level of detail.

• Update documentation as payor policies evolve, maintaining clear version control.

• Proofread and quality-check all documentation for accuracy, consistency, and clarity prior to publication.

• Research and confirm prior authorization and benefit verification requirements across a range of payors (commercial plans, state Medicaid programs, etc.).

• Examine payor-specific submission processes (required documents, portals, fax numbers, CPT code requirements) when existing documentation is unclear, outdated, or lacking.

• Validate information from various sources and assess the reliability of payor guidance before documentation.

⛳️ Requirements

• Foundational understanding of revenue cycle management (RCM), particularly regarding prior authorization procedures.

• Strong technical writing abilities; proven capacity to create clear, structured, and standardized documentation (writing samples or a portfolio are advantageous).

• A history of producing accurate, low-error work, where any mistakes typically occur in non-essential details rather than key facts.

• Experience in developing checklists, SOPs, style guides, or other standardized reference materials.

• Proficiency in annotating or tagging structured content for documentation or data systems.

• Strong research capabilities and comfort in navigating payor portals, websites, and policy documents.

• Exceptional attention to detail.

• Ability to work independently and provide structure to ambiguous or undocumented processes.

• Strong written communication skills and openness to incorporating feedback.

🏝️ Benefits

• Competitive compensation package that includes equity.

• Opportunity to significantly impact healthcare delivery through operational excellence.