(Bilingual) Healthcare Operations Specialist

The (Bilingual) Healthcare Operations Specialist is responsible for supporting client intake, recertification, service maintenance, healthcare operations, nursing documentation review, and insurance authorization processes. This position serves as a liaison between clients, Personal Care Workers (PCWs), healthcare providers, insurance companies, nursing staff, and internal departments to ensure timely and compliant delivery of personal care services. This role requires strong organizational skills, attention to detail, critical thinking, and the ability to manage multiple priorities in a fast-paced healthcare environment. The position is cross-trained in all processing functions and plays an integral role in maintaining compliance with insurance requirements, state regulations, and company policies., Client Services & Communication

• Communicate with clients, physicians, specialists, nurses, insurance representatives, Personal Care Workers (PCWs), clinics, schools, and internal staff regarding patient care coordination and processing updates.

• Answer incoming calls from clients, PCWs, insurance entities, medical clinics, and healthcare providers.

• Provide status updates to clients and PCWs throughout the intake, authorization, amendment, and recertification processes.

• Maintain effective and professional communication with all departments and employees.

• Attend all required meetings, trainings, case reviews, and operational discussions. Healthcare Operations

• Serve as a member of the Healthcare Operations Team supporting client intake, recertifications, amendments, and ongoing service maintenance.

• Obtain medical records from healthcare providers and ensure documentation meets insurance and regulatory requirements.

• Stay informed of current insurance requirements, authorization guidelines, and compliance standards

• Verify physician visits, primary care providers, insurance eligibility, and client coverage through online portals and payer systems.

• Perform insurance verification checks for assigned clients.

• Submit Prior Authorization requests to the State of Wisconsin and insurance companies for personal care services.

• Monitor authorization submissions and follow up on pending approvals, denials, or requests for additional information.

• Process service approvals and prepare client packets.

• Maintain and update active HOLD statuses and workflow tracking on Monday.com and other assigned systems.

• High School Diploma or equivalent required

• Bilingual proficiency preferred

• Ability to work independently and under pressure

• Ability to multitask and manage competing priorities

• Strong attention to detail and organizational skills

• Excellent verbal and written communication skills

• Proficiency in Microsoft Office Suite

• Experience with healthcare documentation, medical records, and insurance verification preferred

• Willingness to participate in ongoing training and cross-functional support

Education

• High School Diploma or GED required

• Additional healthcare administration, medical office, insurance, or healthcare operations experience preferred

401(k), Health insurance, Paid time off, Vision insurance, Dental insurance, Life insurance Full-time Milwaukee, WI 53215, * 401(k)

• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance