Provider Validation Specialist | Remote

• Excellent written English with strong attention to detail.
• Strong research and information-verification skills.
• Ability to analyze multiple sources and identify accurate information.
• Strong organizational and documentation skills.
• Ability to identify discrepancies, missing information, and duplicate records.
• Comfortable working independently and following established processes.
• Strong problem-solving and follow-up skills.
• Ability to work a schedule that overlaps with U.S. Eastern Time business hours.

We are looking for a detail-oriented Provider Validation Specialist to support a medical records retrieval workflow.

In this role, you will research healthcare providers and identify the appropriate custodians for different types of medical records and billing documents. You will verify submission requirements, prepare accurate request information, maintain provider data, and resolve issues that may delay records requests.

The ideal candidate is highly organized, comfortable conducting detailed research, and able to work accurately with healthcare, billing, and provider information.

• →Identify Record Custodians: Research healthcare providers and identify the appropriate custodian for each type of record, including records departments, billing offices, physician groups, radiology providers, ambulance services, and other third-party entities.
• →Verify Submission Requirements: Confirm whether requests must be submitted by fax, email, online portal, or mail, and document exact submission details, contact information, attention lines, and provider-specific requirements.
• →Determine Request Requirements: Identify when requests need to be separated by record type, custodian, or date of service.
• →Prepare Request Information: Ensure authorization documents and request packets meet provider-specific requirements, including required language or provider-specific forms when applicable.
• →Maintain Provider Information: Research existing records before adding new entries and maintain accurate, complete, and duplicate-free provider information.
• →Research and Verify Information: Use available databases, healthcare system websites, provider resources, NPI information, vendor portals, and other reliable sources to verify details. Phone verification may also be required.
• →Resolve Issues: Investigate rejected or delayed requests, identify the cause, make appropriate corrections, and escalate issues when necessary.
• →Maintain Accurate Documentation: Clearly document research findings, submission requirements, provider information, and updates so other team members can act on the information.

Shortlisted candidates may be asked to complete a timed skills assessment independently and without the use of AI tools.

The assessment may evaluate:

• Identifying healthcare providers, custodians, and billing entities
• Determining when requests should be separated
• Verifying submission methods and provider-specific requirements
• Understanding basic HIPAA authorization requirements
• Research persistence and information verification
• Identifying errors, gaps, and duplicate information
• Knowing when to resolve an issue independently and when to escalate

Prior medical records experience is not required. The assessment focuses on research, reasoning, accuracy, and problem-solving skills.

Experience in any of the following areas is an advantage:

• Researching healthcare providers, facilities, or billing entities
• Release of Information (ROI)
• Health Information Management (HIM)
• Medical billing
• Experience with UB-04 or CMS-1500 claim forms
• NPI lookups and verification
• Explanation of Benefits (EOBs)
• Legal support, particularly personal injury or medical malpractice
• Medical records retrieval or release processes
• Experience working with record-release or healthcare information vendors

• Healthcare provider research
• Data verification and accuracy
• Document and information review
• Medical billing knowledge
• Research and investigation
• Database management
• Attention to detail
• Written communication
• Problem-solving
• Organization and follow-through