Operations Specialist MN

Overview:

The Operations Specialist is responsible for executing the branch’s pre-claim review process to ensure all service activity entered in Pavillio is accurate, complete, and ready for billing. This role serves as a critical control point between service delivery and the revenue cycle, proactively identifying and resolving issues that prevent claims from moving forward.

The Operations Specialist works cross-functionally with Client Care, Clinical, Caregivers, and the Revenue Cycle Management (RCM) team to correct errors, resolve documentation gaps, and validate service details prior to claim submission. Success in this role directly supports reducing unbilled services, accelerating cash flow, and improving overall revenue capture for the branch.

Responsibilities:

Pre-Claim Review & Billing Readiness

• Perform detailed review of service activity in Pavillio prior to claim submission
• Identify failed service cards, incomplete records, and discrepancies preventing billing
• Validate that all service details are accurate, authorized, and properly documented
• Confirm required approvals, signatures, and documentation are present before claims move forward

Issue Resolution & Documentation Follow-Up

• Proactively track down missing or incomplete documentation
• Coordinate with caregivers, Client Care Coordinators, and Clinical staff to resolve issues quickly
• Correct service entry errors and ensure alignment with authorizations and care plans
• Monitor unresolved service activity and follow through to timely resolution

Cross-Functional Coordination

• Collaborate with branch teams and the RCM team to address billing-related issues
• Communicate service activity issues and trends to leadership as needed
• Partner with Client Care and Clinical teams to help prevent recurring documentation and entry errors

Process Support & Continuous Improvement

• Identify patterns contributing to unbilled services or claim delays
• Provide feedback on process improvements to reduce errors and rework
• Support consistent service activity and documentation practices across the branch

Qualifications:

Key Outcomes & Performance Indicators

• Reduction in unbilled and delayed services
• Improved first-pass claim acceptance rates
• Faster resolution of failed service cards and documentation gaps
• Improved revenue capture and cash flow

---

Qualifications

• Strong understanding of pre-claim processes, EVV, and service documentation requirements
• High attention to detail with strong problem-solving skills
• Ability to work cross-functionally with operational, clinical, and billing teams
• Experience identifying and resolving workflow or documentation issues
• Comfortable working in fast-paced, high-volume operational environments

---

Systems & Tools

• Pavillio (or similar EVV / service activity platform)
• Billing and documentation tracking systems
• Reporting tools for service activity and claim readiness

---

Reporting Structure

• Reports to: Operations Leadership / RVP
• Works closely with: Client Care, Clinical teams, Caregivers, and Revenue Cycle Management (RCM)

---

Work Environment

• Centralized or branch-based operational role
• Highly collaborative, detail-oriented, and outcome-driven
• In office position Monday-Friday 8:00am-4:30pm
• CBH1