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paycor

Qualification Analyst

MSC
Toledo, USA
Full-time
Mid Level
Hybrid
Discovered 1 months ago

Full Job Posting

  • Competitive Pay
  • Advancement Opportunities

• Medical, Dental & Vision Insurance

  • HSA Account w/Company Contribution
  • Pet Insurance
  • Company provided Life and AD&D insurance
  • Short-Term and Long-Term Disability

• Employee Engagement Opportunities

  • CALM App
  • 401k (with a matching program) / Roth IRA
  • Company Discounts
  • Payactiv/On-Demand Pay
  • Paid vacation, Sick Days, YOU (Mental Health) Days and Holidays

Responsibilities And Job Duties

  • Review medical documentation (prescriptions, clinical notes, CMNs, testing, and other supporting records) to determine whether orders meet qualification criteria.
  • Validate that required clinical data, signatures, dates, and supporting evidence are complete and compliant.
  • Identify missing documentation or discrepancies and route items for correction or follow‑up.
  • Confirm that order details, demographic information, product classification, and supporting materials match documentation.
  • Identify trends or recurring issues that require escalation or workflow improvements.
  • Manage assigned digital work queues to maintain expected turnaround times.
  • Prioritize urgent needs based on patient condition, program requirements, or delivery urgency.

Job Qualifications & Requirements

  • 1–4 years of healthcare documentation, payer review, intake, billing, or clinical operations experience.
  • Strong understanding of clinical documentation, qualification rules, and payer policies.
  • High attention to detail and ability to interpret medical records.
  • Comfort working in digital workflow systems and reviewing system‑suggested information.

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