- Contact healthcare providers, clinic staff, referral sources, and clinical teams to obtain missing documentation, medical records, signatures, chart notes, testing results, and payer-required criteria.
- Review and monitor orders for documentation deficiencies, aging, and risks that could delay progression, prior authorization, claims processing, or patient access.
- Serve as the primary Tier 1 contact for inbound calls, emails, and service requests from providers, clinics, clinicians, referral coordinators, and sales representatives.
- Assess inquiries, provide guidance on order status, documentation and insurance requirements, workflows, and procedures, and resolve issues independently when possible.
- Escalate complex operational, system, reimbursement, and process issues to Tier 2 teams while maintaining ownership and communicating updates through resolution.
- Coordinate handoffs across Prior Authorization, Order Management, Benefits Verification, Revenue Cycle, Operational Excellence, Performance Quality, IT, and other teams.
- Document customer interactions, documentation requests, issue resolutions, and required information accurately and securely in applicable systems.
- Track service metrics and identify recurring inquiry themes, provider confusion, documentation delays, and order progression barriers to support process improvements and reporting.
- Comply with HIPAA, regulatory requirements, company policies, payer guidelines, and service and documentation standards.
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