Care Operations Associate
New
L
LeapSpecialty healthcare
US (Remote), CST business hoursFull-TimeJunior
Salary$51K - $63K; $51K – $63K • Offers Equity
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Job Details
- Languages
- Spanish fluency (spoken and written)
- Experience
- 2+ years in a healthcare administrative or operations role supporting prior authorization or eligibility verification
- Required Skills
- EHRProcess improvement
Requirements
- Have 2+ years of healthcare administrative or operations experience supporting prior authorization or eligibility verification.
- Be familiar with payer portals, prior authorization workflows, and follow-up or appeal processes.
- Be proficient with CRM or EHR systems and document management platforms, including fax.
- Have a track record of managing high volumes of detailed work accurately.
- Be comfortable coordinating across provider offices, payers, pharmacy partners, staffing agencies, and internal teams.
- Be organized, communicate effectively, and work independently during CST business hours in a fully remote setting.
- Spanish fluency (spoken and written) is a bonus.
- Clinical certification or licensure such as CMA, RMA, CPhT, or LPN is a bonus.
- Experience in a healthcare startup or high-growth environment is a bonus.
- Experience in specialty infusion, home infusion, or rare disease programs is a bonus.
Responsibilities
- Run benefit eligibility checks and keep member eligibility status accurate and current.
- Manage medical prior authorization requests, renewals, and extensions across payers and specialty pharmacy partners.
- Prepare and submit prior authorization documentation, track approval status, and escalate stalled or denied authorizations.
- Follow up with provider offices on unsigned documents and orders; process referrals, faxes, and clinical documents.
- Coordinate clinical staffing with staffing agencies and medication shipping with pharmacy partners.
- Answer and route inbound calls, document call details, and follow through on action items.
- Collect, organize, and store member records and clinical documentation in accordance with internal standards and HIPAA requirements.
- Design, document, and improve operational workflows.
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