DMT Clinical Records & Audit Support Specialist

Job Summary

The DMT Clinical Records & Audit Support Specialist assists the Denials Management Team and agencies by coordinating and compiling clinical and administrative records for Medicaid audits and Part B physician services requests.

This position reviews requests to identify the documentation needed, locates and organizes records from available systems, and prepares complete, accurate, and professionally assembled packets for internal review and submission.

The specialist applies clinical knowledge to recognize relevant documentation, identify potential gaps, and communicate follow-up needs while supporting audit tracking, documentation management, and process improvement activities.

Duties & Responsibilities

• Support the Denials Management Team in coordinating and compiling records for Medicaid audits, Part B physician services requests, and other assigned reviews.
• Review audit and documentation request letters to identify the exact records, date ranges, claim information, and submission requirements requested.
• Locate, collect, organize, and compile clinical, billing, administrative, and supporting documentation from electronic medical records and other approved systems.
• Use clinical knowledge to identify relevant documentation and recognize potential gaps, inconsistencies, missing signatures, or incomplete records for escalation to the appropriate reviewer or leader.
• Organize records in the approved packet structure, including indexing, bookmarking, pagination, file naming, and quality review of the final compiled document.
• Compare compiled records to the request and internal checklist to confirm completeness before routing the packet for clinical, audit, or leadership review.
• Communicate clearly with agency staff, physician services teams, clinical personnel, and DMT team members regarding outstanding records, questions, and due dates.
• Maintain accurate audit activity, record-request status, notes, and supporting documentation within DMT applications, Excel, Smartsheet, and designated folders.
• Locate and reference applicable Medicare, Medicaid, CMS, payer, and state regulatory guidelines to support record identification, compilation requirements, and appropriate escalation of questions.
• Protect confidential information and follow HIPAA, company policies, approved submission processes, and applicable payer or regulatory requirements.
• Participate in cross-training, education, and process improvement efforts; promote CAPLICO values and a collaborative, quality-driven culture.

Additional information

The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.

Job Requirements

• Current Licensed Practical Nurse (LPN) license preferred; candidates with substantial clinical knowledge or relevant healthcare experience may be considered.
• Experience in Medicaid Home Health, Hospice, home care, or Part B physician services strongly preferred.
• Clinical knowledge sufficient to recognize common medical record components, plans of care, orders, visit or procedure documentation, and supporting billing documentation.
• Previous experience with healthcare audits, medical record requests, additional documentation requests, payer reviews, or record compilation preferred.
• Ability to locate, research, and reference Medicare, Medicaid, CMS, payer, and applicable state regulatory guidelines and documentation requirements; prior experience using regulatory resources preferred.
• Experience navigating electronic medical records and healthcare information systems; Homecare Homebase or physician practice systems experience preferred.
• Comfortable using PDF editing and document-assembly tools, including combining files, organizing pages, creating bookmarks, and performing final packet quality checks.
• Proficiency with Microsoft Office, including Excel and Outlook; experience with Smartsheet, SharePoint, Teams, or similar platforms preferred.
• Strong attention to detail with the ability to follow exact request language, checklists, naming conventions, and established workflows.
• Detail and deadline oriented with the ability to organize, prioritize, and manage multiple assignments in a fast-paced environment.
• Demonstrates initiative in researching and resolving routine issues and appropriately escalating clinical, regulatory, or documentation concerns.
• Clear written and verbal communication skills with the ability to collaborate effectively with clinical and non-clinical stakeholders.
• Ability to work independently and as part of a team, adapt to evolving requirements, accept feedback, and maintain confidentiality.

Location: Remote

Additional Benefits

• True Work-Life balance – We believe in taking care of yourself before you take care of others!
• Full benefits package (medical, dental, vision, 401(k) with match)
• Paid time off, holiday pay, and professional development
• Your voice matters! - Work with other passionate and high-achieving leaders who care deeply about patient outcomes and team success.