Healthcare Operations Specialist

Overview

We are seeking a skilled Healthcare Administrative and Operations Specialist to join remotely within the United States. This contract-based position focuses on managing and optimizing back-office workflows critical to medical practices, hospitals, and health plans. It is a healthcare administration role and does not involve medical coding or clinical care activities.

Key Responsibilities

• Oversee patient registration, appointment scheduling, insurance eligibility verification, benefits interpretation, patient intake, and referral management processes.
• Facilitate prior authorization tasks, including initiation, submission, monitoring, and resolution of authorization requests via payer portals.
• Manage claims and revenue cycle procedures such as claim submissions, status follow-ups, handling denials, appeals, accounts receivable follow-up, and resolving rejections.
• Review remittance advice and payment workflows encompassing Electronic Remittance Advice (ERA), payment posting, and reconciliation activities.
• Support provider and payer operations by assisting with credentialing, provider enrollment, configuring payer setups, managing appeals and grievances, and member/provider services.
• Administer health information workflows, medical records management, release of information, and day-to-day operational tasks of the practice.
• Utilize comprehensive healthcare system knowledge and administrative workflow expertise to ensure successful project execution.

Qualifications and Skills

• Minimum of 3 years of direct, hands-on experience in healthcare administration, operations, or back-office healthcare roles.
• Current engagement in a healthcare administrative position.
• Familiarity with healthcare administrative platforms such as payer portals, electronic health record (EHR) systems, practice management software, and clearinghouse systems.
• Experience with platforms like Availity, Optum/Change Healthcare, Waystar, Office Ally, UnitedHealthcare Link, Blue Cross Blue Shield, Aetna, or similar payer systems.
• Deep understanding of healthcare workflow processes, documentation, and operational procedures.
• Strong attention to detail, effective problem-solving capabilities, and proficient written communication skills.
• Must reside within the United States.

Preferred Backgrounds

• Practice Administrator or Medical Office Manager
• Revenue Cycle Specialist or RCM Analyst
• Medical Billing Coordinator or Full-Cycle Biller
• Patient Access Lead, Intake or Referral Coordinator
• Prior Authorization Specialist
• Denials or Claims Resolution Specialist
• Credentialing or Provider Enrollment Specialist
• Health Plan or Payer Operations Specialist
• Health Information Management or Medical Records Administrator

Compensation and Engagement

• Competitive payment rate ranging from $40 to $50 per hour.
• Payments are made weekly.
• Engagement as an independent contractor.