Provider Operations Specialist

What You'll Do

• Log and track all incoming medical records requests across payer portals, fax, mail, and email, maintaining accurate records of deadlines, reference numbers, and status.
• Prepare and consolidate required documentation into complete, organized packets for each request.
• Review packets for accuracy, including patient identity, dates, and completeness, prior to submission.
• Submit completed packets to the requesting payer or entity through the appropriate channel and confirm receipt when required.
• Identify and escalate missing, inconsistent, or questionable documentation before it impacts a submission.
• Collaborate with the Revenue Cycle Management (RCM) team and Physician Operations to source claims, billing, and provider documentation needed for audit responses.
• Maintain and update the request tracking log, escalating at-risk deadlines proactively.
• Maintain organized digital recordkeeping to support compliance and audit readiness.

How Success is Measured (KPIs)

• Submission packets are accurate and complete, with no cross-patient or documentation errors, prior to submission.
• Zero missed payer deadlines across the active caseload.
• Documentation gaps or inconsistencies are identified and flagged internally prior to submission.
• The request tracking log remains current and accurate at all times.

Must-Have Qualifications

• Minimum 2 years of experience in a high-paced medical office setting, managing incoming medical records requests and compiling clinical documentation.
• Working knowledge of medical records workflows, HIPAA requirements, and release-of-information processes.
• Experience working with EHR systems.
• High attention to detail, with the ability to accurately cross-reference dates, patient identifiers, and documentation across multiple sources.
• Strong organizational skills, with the ability to coordinate multiple requests and deadlines simultaneously without losing track of status or priority.
• Comfortable learning and adapting to new software tools and digital filing systems.
• Strong written and verbal communication skills.
• Ability to thrive in a dynamic, evolving startup environment.

Nice-to-Haves

• Experience with payer audits, ADRs, SIU requests, or Medicare Risk Adjustment/HCC documentation.
• Familiarity with remote patient monitoring (RPM/RTM) billing and CPT coding basics.
• Experience working in or with skilled nursing facilities (SNFs).
• Experience with esMD, Kiteworks, or other secure health information exchange portals.
• Proficient with PDF tools, spreadsheets, and document assembly software.