[Hiring] Health Services Specialist @Comagine Health

Role Description

As a Health Services Specialist, you'll play an important role in supporting our healthcare operations and ensuring providers and members receive responsive, accurate, and professional service.

Your day-to-day responsibilities will include:

• Support healthcare providers: Assist providers with submitting medical service requests, using online provider portals, understanding documentation requirements, and navigating medical management processes.
• Process healthcare requests: Receive and coordinate referrals, prior authorization requests, utilization review cases, and case management requests through electronic portals, phone, fax, and other communication channels.
• Review documentation for accuracy: Verify that service requests are complete and accurate, identify missing medical information, and follow up with providers or other appropriate contacts.
• Deliver excellent customer service: Answer inbound calls, respond to provider and member questions, document interactions, and help resolve routine inquiries and concerns.
• Maintain accurate healthcare records: Enter information into electronic healthcare management systems, upload medical documentation, organize case files, and maintain detailed records.
• Support utilization management: Work alongside clinical reviewers and physicians to process review outcomes, verify determination information, and prepare accurate notification letters.
• Coordinate care management services: Help schedule assessments, coordinate transportation or accommodation requests, obtain necessary consents, and assist with non-clinical care coordination.
• Collaborate with clinical teams: Communicate with nurses, physicians, case managers, and other healthcare professionals to support timely processing of requests.
• Additional responsibilities may include:
  • Completing scripted clinical review screenings and referring cases requiring clinical judgment to qualified clinical staff.
  • Communicating service determinations to providers following physician review, as directed.
  • Supporting quality assurance reviews, training activities, and process improvements.
  • Assisting with case closure and maintaining compliance with program requirements.

Qualifications

• High school diploma or GED.
• At least 2 years of related work or customer service experience.
• At least 1 year of experience working in a healthcare setting.
• Strong written and verbal communication skills.
• Excellent attention to detail, organization, and follow-through.
• Ability to manage multiple priorities while maintaining accuracy.
• Strong customer service skills and a professional, solutions-focused approach.
• Ability to work collaboratively with healthcare providers, clinical professionals, and team members.
• Comfort using computers, electronic records, and multiple software applications.

Requirements

• 2 or more years of healthcare experience (preferred).
• Experience as a Medical Assistant, Nursing Assistant, Patient Services Representative, Medical Office Specialist, or Healthcare Coordinator (preferred).
• Post-secondary education or certification in healthcare administration or a related field (preferred).
• Familiarity with prior authorizations, utilization management, medical terminology, case management, or insurance processes (preferred).
• Experience working with electronic health records, healthcare portals, or medical management systems (preferred).
• No professional healthcare license is required for this position.

Benefits

• Opportunity to apply your healthcare experience in a role that supports better care and meaningful outcomes.
• Join a mission-driven organization that values collaboration, professionalism, continuous improvement, and the contributions of its employees.

Company Description

Comagine Health is a national nonprofit healthcare consulting organization dedicated to improving healthcare quality, access, and outcomes. We collaborate with healthcare providers, health plans, government agencies, and community partners to help create a more effective, equitable, and patient-centered healthcare system.