Analysis Skills, Billing, Calendar Management, Claims Processing, Communication Skills, Data Entry, Demographics, Detail Oriented, ICD-10, ICD-9, Insurance, Managed Care, Medical Records, Medical Terminology, Microsoft Office, Multitasking, Onboarding, Organizational Skills, Outpatient Care, Patient Care, Patient Care Authorizations, Problem Solving Skills, Process Management, Time Management
Job Title: Operations Specialist
Location: Houston, TX (Hybrid)
Duration: 3 Months
Pay Rate: $30.00 - $33.00/hour (W2)
Work Schedule
- Hybrid work arrangement
- First 3 months: 4 days in office, 1 day remote
- After 3 months: 3 days in office, 2 days remote
- Monday–Friday with flexible working hours
Position Summary
Responsible for insurance verification, referral management, pre-certification/pre-authorization, patient scheduling support, claims processing, and maintaining accurate patient and insurance records. Requires strong attention to detail, analytical thinking, and experience in managed care and healthcare operations.
Key Responsibilities
- Complete patient demographic and insurance information accurately in the system.
- Verify insurance eligibility and benefits with insurance providers.
- Obtain and document referrals and referral modifications for specialty care and testing.
- Secure and document pre-certification/pre-authorization numbers prior to procedures and diagnostics.
- Assist with scheduling new patient appointments.
- Create and distribute inpatient and outpatient service lists and manifests to clinical teams.
- Ensure all claims-related data is completed and routed to billing within deadlines.
- Distribute daily admit lists by 1:00 PM and coordinate with pre-certification teams.
- Correct account errors within assigned timelines.
- Maintain communication between physicians, insurance companies, and internal teams regarding authorization status.
- Maintain productivity of 30 authorizations per day with accuracy after onboarding.
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- Three days in office after initial onboarding
- Two days remote thereafter
Required Qualifications
- Minimum 2 years of experience in pre-certification or insurance authorization
- Knowledge of managed care processes: referrals, verification, pre-certification
- Understanding of medical terminology
- Familiarity with ICD-9 and ICD-10 coding
- Strong analytical and problem-solving skills
- Excellent attention to detail and accuracy
- Ability to multitask in a fast-paced environment
- Strong communication and organizational skills
- Proficiency in Microsoft Office and Teams
- Accurate data entry skills
- Ability to work occasional overtime when needed
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