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 care initiation.

• Maintain precise and up-to-date eligibility information for all active members within our systems.

• Oversee the complete process of medical prior authorization requests, renewals, and extensions across various payers and specialty pharmacy partners.

• Prepare and submit prior authorization documentation, monitor approval progress, and escalate any stalled or denied authorizations to prevent care delays.

• Pursue unsigned documents and orders by actively following up with provider offices to ensure no items remain unresolved.

• Manage incoming referrals, faxes, and clinical documents, directing each to the appropriate destination.

• Coordinate clinical staffing with staffing agencies to guarantee that providers are available for each member's treatment needs.

• Organize medication shipping with pharmacy partners to ensure timely delivery of the correct therapy.

• Respond to inbound calls from providers, pharmacy partners, and occasionally members, prioritizing and directing each inquiry to the correct team member.

• Accurately document call details and ensure follow-through on any assigned action items.

• Collect, organize, and timely store member records and clinical documentation with accuracy.

• Ensure all files comply with internal standards and adhere to HIPAA regulations.

• Develop, document, and continually enhance the workflows associated with the tasks outlined above—transforming manual and ad hoc processes into systematic operations as we expand.

⛳️ Requirements

• Minimum of 2 years' experience in a healthcare administrative or operations position with a focus on prior authorization or eligibility verification.

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

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

• Demonstrated ability to manage a high volume of detailed tasks without losing track of important elements.

• Comfortable coordinating among provider offices, payers, pharmacy partners, staffing agencies, and internal teams.

• Excellent organizational and communication skills, with the ability to work independently during CST business hours in a fully remote environment.

🏝️ Benefits

• Competitive salary.

• Fully remote work opportunity.

• Comprehensive health, dental, and vision insurance.

• 401(k) retirement plan.

• A unique opportunity to establish operational infrastructure from the ground up at a rapidly expanding company where your contributions directly facilitate patient treatment.