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Healthcare Operations Specialist @Pearl

[Hiring] Healthcare Operations Specialist @Pearl

Apr 09, 2025 - Pearl is hiring a remote Healthcare Operations Specialist. đź’¸ Salary: very competitive - based on experience. đź“ŤLocation: Northern America, Americas, Latin America (LATAM), Europe, EMEA, USA, UK, Canada.

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Role Description

We’re looking for a Healthcare Operations Associate to own key workflows that power the clinics on our platform. You’ll be on the front lines of ensuring families get approved, schedules run smoothly, and providers get paid. If you’re organized, detail-obsessed, and want to be part of transforming autism care, we want to hear from you.

Key Responsibilities

  • Denial Management: Track, investigate, and resolve denied claims to ensure maximum reimbursement.
  • State Medicaid EVV Management: Monitor and troubleshoot Electronic Visit Verification (EVV) compliance across multiple state systems.
  • Credentialing & Contracting: Submit forms, follow up with payers, and escalate issues to ensure providers are enrolled and contracted quickly.
  • Schedule Management: Help clinicians stay productive and compliant by managing weekly therapy schedules and ensuring authorized hours are delivered.
  • Verification of Benefits (VOBs): Confirm insurance coverage and benefits with payers, and communicate details clearly to both families and providers.
  • Prior Authorizations: Prepare and submit prior authorization requests, and follow up to ensure timely approvals.
  • Week 1 Ownership:
    • Gain access to core systems (e.g., EMR, EVV platforms, payer portals) and complete onboarding on Alpaca’s operations and support workflows.
    • Establish daily check-ins or Slack updates with your operations lead to align on priorities, track progress, and flag blockers early.
    • Shadow ongoing processes across denial management, credentialing, and schedule coordination to understand clinic pain points and high-priority workflows.
    • Begin a light audit of assigned clinics' operational health—review claims backlog, authorization expirations, and schedule gaps to identify areas needing immediate attention.

Qualifications

  • 2+ years of experience in healthcare operations, revenue cycle, or ABA administration preferred
  • Experience with Medicaid, EVV platforms, or insurance credentialing is a strong plus
  • Organized, proactive, and comfortable managing multiple priorities
  • Clear communicator—both in writing and over the phone
  • Mission-driven: passionate about improving autism care for families

Requirements

  • Nice-to-Haves:
  • Knowledge of medical coding: Familiarity with HCPCS Level II, ICD-10-CM, and CPT® codes
  • Denials management experience: Ability to identify, analyze, and appeal denied claims, while implementing strategies to reduce future denials
  • Understanding of the healthcare revenue cycle: Knowledge of how billing, coding, insurance policies, and denials interact within a revenue cycle
  • Insurance policy knowledge: Comfortable interpreting EOBs, understanding coverage limits, and pinpointing reasons for claim denials

Benefits

  • Remote Work: Fully remote—work from anywhere
  • Generous PTO: Ample paid time off to rest and recharge
  • Direct Mentorship: Grow through guidance from international industry experts
  • Learning & Development: Ongoing access to resources for professional growth
  • Global Networking: Work and connect with professionals around the world
  • Work-Life Balance: Flexible hours that support a healthy work-life balance

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đź“Ť Be aware of the location restriction for this remote position: Northern America, Americas, Latin America (LATAM), Europe, EMEA, USA, UK, Canada
‼ Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more.
Back to Remote jobs  >   All others
Healthcare Operations Specialist @Pearl
All others
Salary đź’¸ very competitive - based on experience
Remote Location
Northern America, Americas, Latin America (LATAM), Europe, EMEA, USA, UK, Canada
Job Type full-time
Posted Apr 09, 2025
Apply for this position Unlock 53,612 Remote Jobs
️
đź“Ť Be aware of the location restriction for this remote position: Northern America, Americas, Latin America (LATAM), Europe, EMEA, USA, UK, Canada
‼ Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more.
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