This role oversees daily workflow, productivity, quality, training, coaching, and escalation support to ensure documentation reviews are completed accurately, consistently, and timely. The Supervisor serves as a subject matter expert for documentation review standards, payer requirements, internal workflows, and quality expectations while supporting continuous improvement, team development, and compliance with established guidelines, standard operating procedures, and privacy requirements.
Core Competencies
- Team Leadership & Coaching - Leads, supports, coaches, and develops Order Documentation Specialists to promote consistent performance, accountability, and professional growth.
- Documentation Review Expertise - Provides guidance on medical records, claims documentation, and supporting clinical information in a non-clinical capacity.
- Payer Criteria & Medical Necessity Oversight - Ensures the team applies established insurance medical necessity criteria, payer requirements, internal review standards, and workflow instructions consistently.
- Quality Management - Monitors documentation accuracy, identifies trends, provides feedback, and supports corrective action when quality expectations are not met.
- Communication & Escalation - Communicates clearly with specialists, internal teams, leadership, and cross-functional partners regarding documentation findings, escalations, process changes, and performance expectations.
- Process & Compliance Discipline - Reinforces adherence to established criteria, checklists, standard operating procedures, privacy requirements, and escalation pathways.
- Workflow & Productivity Management - Manages team workload, monitors productivity, removes barriers, and ensures timely completion of documentation review activities.
Essential Duties & Responsibilities
- Supervise the daily activities of Order Documentation Specialists responsible for reviewing medical records, claims documentation, payer criteria, and related support materials.
- Assign, monitor, and balance team workload to ensure documentation reviews, authorizations, follow-ups, and related tasks are completed accurately and within established timelines.
- Provide coaching, training, feedback, and day-to-day support to specialists regarding documentation review standards, payer requirements, workflow expectations, and system usage.
- Review escalated cases and provide guidance when documentation is incomplete, inconsistent, unclear, or requires additional review before next steps are taken.
- Monitor team quality, productivity, timeliness, and accuracy metrics; identify trends, performance gaps, and opportunities for improvement.
- Conduct quality reviews, calibration discussions, and performance follow-up to promote consistent application of payer criteria, internal review standards, and documentation expectations.
- Ensure documentation review outcomes are recorded accurately and consistently in designated systems, trackers, or case management tools.
- Partner with internal teams to resolve documentation issues, clarify requirements, support authorization follow-up, and improve handoffs across the order and claims process.
- Maintain confidentiality of patient, provider, and claims information in accordance with company policies and applicable privacy standards, and ensure team adherence to those expectations.
- Support onboarding, training, refresher education, and process updates related to payer rules, documentation standards, internal procedures, and compliance requirements.
- Escalate recurring issues, workflow barriers, payer changes, or documentation trends to leadership with recommended actions or process improvements.
- Participate in department planning, workflow improvement initiatives, audit preparation, reporting, and other supervisory or administrative duties as assigned.
Qualifications
Required
- High school diploma or equivalent required; associate degree or relevant healthcare coursework preferred.
- Minimum of five years of experience reviewing and interpreting medical records, claims documentation, clinical documentation, insurance documentation, prior authorization records, or related healthcare documentation.
- Minimum of three years of experience in supervisory, training, quality review, or workflow oversight required in the US Healthcare space.
- Working knowledge of medical terminology and the ability to understand documentation related to patient history, diagnoses, treatment plans, orders, and supporting clinical notes.
- Strong ability to coach team members, explain documentation expectations, and provide clear feedback in a professional and constructive manner.
- Strong attention to detail and ability to identify documentation gaps, inconsistencies, discrepancies, quality trends, and process improvement opportunities.
- Excellent written and verbal communication skills, including the ability to summarize findings, communicate expectations, and escalate issues clearly and professionally.
- Ability to interpret and reinforce established criteria, checklists, standard procedures, payer requirements, and leadership direction.
- Proficiency with Microsoft Office applications and the ability to use claims, documentation, authorization, reporting, or case management systems.
- Ability to manage competing priorities, team workload, escalations, and performance expectations in a fast-paced environment.
Preferred
- Experience supervising or leading a documentation review, prior authorization, utilization review support, durable medical equipment, home health, specialty pharmacy, claims, or healthcare operations team.
- Experience conducting quality reviews, performance coaching, team training, workflow audits, or calibration sessions.
- Experience using electronic medical record systems, payer portals, claims platforms, document management tools, productivity trackers, or reporting dashboards.
- Familiarity with payer guidelines, coverage policies, audit documentation, medical review workflows, and healthcare compliance requirements.
High school diploma or equivalent; 5+ years reviewing medical records/claims documentation; 3+ years supervisory or quality oversight in US healthcare; medical terminology knowledge; Microsoft Office proficiency; strong communication and attention to detail.
Key Responsibilities
- supervising documentation review
- coaching team members
- managing workflow
Skills & Tools
Microsoft Office, electronic medical record systems, payer portals, claims platforms, document management tools, productivity trackers, reporting dashboards
Job Details
- Category: Healthcare Services - Allied Health
- Seniority: Senior Level
- Commitment: Full Time
- Workplace: Remote — United States
- Salary: USD 72,000 – 72,000 / year
- Languages: English
About Altivera Medical
A healthcare company providing medical documentation and operational services. — Industry: Healthcare