Specialist, Qualifications

About the role

As a Specialist in the Customer Connect Center (CCC) at Synapse Health, you play a crucial role in ensuring clinical accuracy, documentation quality, and regulatory compliance. You will review, validate, and maintain medical documentation to ensure orders meet payer, clinical, and operational requirements before fulfillment.

Responsibilities

• Manage incoming referrals, ensuring all required clinical and supporting documentation is obtained within established timelines.
• Review, record, and maintain all incoming orders and documentation within electronic medical records and document management systems.
• Cook up and process precertification and recertification requirements for Durable Medical Equipment (DME).
• Apply payer and insurance provider guidelines to determine documentation requirements and authorization eligibility.
• Perform routine audits of patient medical files to ensure accuracy, completeness, and compliance with internal standards and regulatory requirements.
• Identify documentation discrepancies, errors, or missing information and work directly with referral sources and provider offices to obtain clarification or corrections.
• Prepare, convert, and maintain paper and electronic documentation in accordance with organizational document storage and retention policies.
• Maintain compliance with policies and procedures related to documenting, storing, and retrieving medical, legal, and insurance information in accordance with federal, state, and local regulations.
• Respond to inquiries related to patient charts, documentation status, and qualification requirements.
• Run insurance cost estimates, collect patient responsibility information, and explain rental versus purchase options when applicable.
• Present and distribute provider documentation and product education materials to patients, coordinating electronic signature collection as required.
• Support educational efforts by contributing to instructional materials and assisting with training for healthcare personnel, as needed.
• Advocate and act with urgency to ensure the needs of patients, prescribers, and referral sources are met efficiently.
• Deliver a high-quality patient experience while meeting established performance metrics, including productivity, documentation accuracy, call quality, member satisfaction, first call resolution, and attendance.
• Maintain strict confidentiality of patient health information and adhere to HIPAA and organizational privacy standards.
• Partner with program leadership and senior team members on escalated cases or complex qualification questions.
• Participate in an on-call rotation to support after-hours member requests.
• Perform additional duties as assigned to support operational and team objectives.

Requirements

• 2+ years of recent experience in healthcare equipment or durable medical equipment (DME), including roles in qualifications, customer service, logistics, transitions, or related functions.
• Strong proficiency in Microsoft Office applications and the ability to quickly learn department- and role-specific systems.
• Excellent organizational skills with the ability to manage high volumes of documentation accurately and efficiently.
• Eloquent verbal and written communication skills, including collaboration with provider offices and internal teams.
• Strong analytical and problem-solving abilities to identify documentation gaps, interpret guidelines, and resolve issues.
• A high attention to detail and a strong commitment to accuracy and compliance.
• Must live within a commutable distance to Skokie, IL 60076 as this is a fully onsite position.

Qualifications

• Customer-Focused: Builds strong relationships and delivers patient- and provider-centered solutions.
• Effective Communicator: Clearly conveys documentation requirements and expectations across multiple audiences.
• Nimble Learner: Quickly adapts to changing payer guidelines, workflows, and systems.
• Action-Oriented: Approaches challenges with urgency, accountability, and follow-through.
• Process-Minded: Identifies opportunities to improve documentation quality and operational efficiency.
• Tech-Savvy: Comfortable learning and adopting new tools, platforms, and healthcare technologies.

Benefits

• Professional growth opportunities with compelling career paths.
• Healthy work-life balance supported by generous paid time off (PTO).
• Comprehensive benefits package, including medical, dental, vision, STD & LTD insurance for full-time team members.
• 401(k) savings plan with employer matching contributions.

Pay

The pay range for this position is $17 – $21 per hour. This range reflects the anticipated compensation at the time of posting. Final compensation will be based on factors such as relevant experience, demonstrated skills, internal equity, and prevailing market conditions. Compensation discussions are encouraged throughout the hiring process.

Schedule

This is a fully onsite position located in Skokie, IL 60076.