Care Operations Associate

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct benefit eligibility assessments to verify coverage, cost-sharing, and authorization prerequisites prior to the commencement of care.

• Maintain accurate and up-to-date eligibility status for all active members.

• Oversee medical prior authorization requests, renewals, and extensions across various payers and specialty pharmacy partners from start to finish.

• Prepare and submit necessary prior authorization documentation.

• Monitor approval statuses and escalate any stalled or denied authorizations to prevent delays in care.

• Proactively follow up with provider offices regarding unsigned documents and orders.

• Process incoming referrals, faxes, and clinical documents, ensuring proper routing.

• Coordinate clinical staffing in collaboration with staffing agencies.

• Manage medication shipping logistics with pharmacy partners.

• Respond to and triage incoming calls from providers, pharmacy partners, and, occasionally, members.

• Accurately document call details and diligently follow through on action items.

• Represent Leap with professionalism and a service-oriented mindset.

• Collect, organize, and securely store member records and clinical documentation.

• Ensure that files comply with internal standards and HIPAA regulations.

• Design, document, and continuously enhance operational workflows.

• Report directly to the Head of Member Ops. & Strategy.

⛳️ Requirements

• Minimum of 2 years in a healthcare administrative or operations position relevant to prior authorization or eligibility verification.

• Knowledge of payer portals, prior authorization workflows, and follow-up/appeal processes.

• Proficient in CRM or EHR systems and document management platforms, including fax capabilities.

• Demonstrated ability to manage a high volume of detailed work with accuracy.

• Comfortable liaising with provider offices, payers, pharmacy partners, staffing agencies, and internal teams.

• Excellent organizational and communication skills.

• Ability to work independently during CST business hours in a fully remote environment.

• Clinical certification or licensure (such as CMA, RMA, CPhT, LPN, or similar) is preferred.

• Experience within a healthcare startup or rapidly growing environment is advantageous.

• Familiarity with specialty infusion, home infusion, or rare disease programs is a plus.

• Proficiency in Spanish, both spoken and written, is a bonus.

• Legal authorization to work in the United States is required upon application.

🏝️ Benefits

• Competitive salary.

• Stock options/equity.

• Comprehensive health, dental, and vision coverage.

• 401(k) retirement plan.

• Fully remote work environment.

• Opportunity to establish operational infrastructure from the ground up in a fast-growing company.

• Limit of up to 3 applications within any 90-day period across positions in this group.

• Ability to reapply for the same role after 60 days if not selected.