Healthcare Operations Specialist

• Analyze healthcare claims, reimbursement issues, and payer policy discrepancies.
• Conduct root cause analysis to identify and resolve operational and payment-related issues.
• Support payer operations and contract-related activities.
• Research and resolve escalated claims, reimbursement, and payer concerns.
• Review and interpret payer policies, reimbursement guidelines, and documentation requirements.
• Assist with audits, appeals, compliance reviews, and operational initiatives.
• Utilize Salesforce to manage workflows, cases, escalations, and reporting.
• Identify trends and recommend process improvements to enhance operational performance.
• Collaborate with internal stakeholders to resolve issues and improve efficiency.
• Maintain accurate documentation, reporting, and operational records.

A growing healthcare organization is seeking a detail-oriented and analytical Healthcare Operations Specialist to support payer operations, claims analysis, compliance activities, reimbursement investigations, and operational process improvement initiatives.

This role is ideal for someone who enjoys solving complex problems, identifying root causes, researching payer-related issues, and collaborating across multiple departments to drive successful outcomes. The ideal candidate thrives in a fast-paced environment, communicates effectively, and can balance multiple priorities while maintaining a high level of accuracy., * 3+ years of experience in healthcare operations, payer operations, healthcare administration, claims analysis, revenue cycle, provider relations, or related healthcare fields.

• Experience working with healthcare claims, reimbursement processes, payer policies, appeals, denials, or healthcare operations.
• Strong analytical skills and experience performing root cause analysis.
• Salesforce experience is required.
• Excellent communication and relationship-building skills.
• Strong attention to detail and organizational abilities.
• Ability to learn quickly and adapt in a fast-paced environment.

Preferred

• Experience with Medicare, Medicaid, and commercial insurance plans.
• Experience supporting audits, appeals, grievances, or compliance-related initiatives.
• Knowledge of provider contracting, provider relations, credentialing, revalidation, or enrollment processes.
• Strong Excel and reporting skills., We’re looking for someone who:
• Enjoys investigating issues and uncovering solutions.
• Has an inquisitive and analytical mindset.
• Communicates effectively with a variety of stakeholders.
• Maintains accuracy while managing competing priorities.
• Thrives in a collaborative, fast-paced environment.
• Is comfortable navigating healthcare regulations, payer requirements, and operational workflows.

$67,000-$75,000 annually Monday-Friday | 8:00 AM - 4:30 PM (Flexible within normal business hours in your time zone) Temp-to-Hire, * Medical, dental, and vision coverage

• Life insurance and short-term disability
• Accident and critical illness coverage
• Earned safe and sick time
• Employee discount programs

Upon Permanent Hire

• Generous paid time off package
• Medical, dental, and vision
• Annual bonus opportunities
• 401(k) with company contributions
• Tuition reimbursement and student loan assistance
• Cell phone and internet reimbursement
• Career growth and professional development opportunities

Why You’ll Love Working Here

• Fully remote work environment
• Meaningful, mission-driven work
• Collaborative and supportive team culture
• Employee ownership opportunities
• Strong work-life balance and scheduling flexibility
• Leadership that values innovation and new ideas
• Opportunities for advancement and professional growth

If you’re passionate about healthcare operations, enjoy solving complex challenges, and want to make a meaningful impact, we’d love to connect with you.