Healthcare Operations Specialist

Overview

Looking for full-time work (8 hours/day)

at $9.91/hour ($1,920.00/month)

Associates degree

Last Active

July 14th, 2026 (9 days ago)

Member Since

May 25th, 2026

Profile Description

Are delayed prior authorizations, endless insurance hold times, and constant inbound phone lines overwhelming your clinic’s front-desk staff?

I help US-based private practices, specialist clinics, and telehealth providers reclaim their time and protect their revenue. By taking over high-volume patient/provider phone queues and back-office clinical workflows, I ensure your local team can focus entirely on face-to-face patient care.



With nearly a decade of deep healthcare operations experience handling workflows for major US payers (including Wellmark, Alignment Health, and EmblemHealth), I seamlessly step into your operations as a fully remote, 100% HIPAA and Data Privacy Certified Healthcare VA.



Here is how I add immediate value to your practice:

FRONT-OFFICE COMMUNICATION (INBOUND & OUTBOUND)

Manage high-volume inbound inquiries with a professional, empathetic approach, resolving complex member and provider questions on the first call.

Conduct proactive outbound operations to coordinate with physician networks, track down critical clinical data, and follow up on pharmacy benefits.

PRIOR AUTHORIZATIONS & CLINICAL TRIAGE

Streamline pre-service and admission case authorizations, ensuring 100% data integrity before Utilization Management (UM) reviews.

Proactively chase down missing documentation (like patient "last seen" dates) to ensure absolute compliance with payer guidelines.

INSURANCE VERIFICATION & DME SPECIALIZATION

Execute end-to-end processing for Durable Medical Equipment (DME) benefits, specifically handling complex eligibility checks for Continuous Glucose Monitors (CGMs).

Break down complex Medicaid, Commercial, and Pharmacy benefits so patients know their coverage upfront.

CLAIMS, BILLING & TECHNICAL FLUENCY

Systematically resolve billing disputes, manage account reconciliations, and handle technical system navigation effortlessly using tools like Salesforce, Avaya, Genesys, and Talkdesk.

If your front desk is stretched thin by endless phone calls and insurance paperwork, let’s talk about how I can ease the burden.

D ---------- directly here on LinkedIn or email me at ---------- to discuss how I can support your clinic.