Health Services Specialist

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

📋 Description

• Assist healthcare providers in submitting medical service requests via online provider portals, understanding documentation requirements, and navigating medical management processes.

• Receive and coordinate referrals, prior authorization requests, utilization review cases, and case management inquiries through electronic portals, phone, fax, and various communication channels.

• Ensure that service requests are complete and accurate, identify any missing medical information, and follow up with providers or other relevant contacts.

• Handle inbound calls, address provider and member inquiries, document interactions, and aid in resolving routine questions and concerns.

• Input information into electronic healthcare management systems, upload medical documentation, organize case files, and maintain comprehensive records.

• Collaborate with clinical reviewers and physicians to process review outcomes, verify determination information, and prepare precise notification letters.

• Assist in scheduling assessments, coordinating transportation or accommodation requests, securing necessary consents, and supporting non-clinical care coordination.

• Communicate with nurses, physicians, case managers, and other healthcare professionals to ensure timely processing of requests.

• Conduct scripted clinical review screenings and refer cases needing clinical judgment to qualified clinical staff.

• Relay service determinations to providers following physician review, as directed.

• Contribute to quality assurance reviews, training initiatives, and process enhancements.

• Assist with case closure while ensuring compliance with program requirements.

⛳️ Requirements

• High school diploma or GED.

• Minimum of 2 years of relevant work or customer service experience.

• At least 1 year of experience in a healthcare environment.

• Strong written and verbal communication abilities.

• Exceptional attention to detail, organizational skills, and follow-through.

• Capability to manage multiple priorities while ensuring accuracy.

• Excellent customer service skills with a professional, solutions-oriented approach.

• Ability to collaborate effectively with healthcare providers, clinical professionals, and team members.

• Proficiency in using computers, electronic records, and various software applications.

• Preferred: 2 or more years of experience in healthcare.

• Preferred: Background 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 with electronic health records, healthcare portals, or medical management systems.

• No professional healthcare license is required for this position.

🏝️ Benefits

• Comprehensive health, dental, and vision insurance.

• Flexible working hours and remote work options.

• Professional development and training opportunities.

• Employee wellness programs and initiatives.

• Retirement savings plans with company matching.