Healthcare Administrative Specialist

Key Responsibilities

• Manage patient registration, scheduling, and appointment coordination.
• Perform insurance eligibility verification and benefits interpretation.
• Oversee patient intake and referral management processes.
• Initiate, submit, and monitor prior authorization requests through payer portals.
• Carefully coordinate with providers and insurance companies to ensure timely approvals.
• Submit insurance claims and monitor claim status.
• Investigate denials, manage appeals, and resolve claim rejections.
• Conduct accounts receivable follow-up to ensure timely reimbursement.
• Process Electronic Remittance Advice (ERA).
• Post payments accurately and reconcile remittances with clinical charges.
• Aid in payment reconciliation and financial reporting activities.
• Manage provider credentialing and enrollment activities.
• Support payer configuration and maintenance.
• Handle provider and member services, appeals, and grievance processes.
• Administer medical records and release of information requests.
• Support daily medical office and practice administration activities.
• Ensure documentation and operational processes remain compliant with organizational policies.

Required Qualifications

• Minimum 3 years of hands-on experience in a healthcare administrative or back-office operations role.
• Current employment within a healthcare administrative environment.
• Strong working knowledge of industry-standard systems, including: Payer portals such as Availity, Optum/Change Healthcare, Waystar, Office Ally, or payer-specific portals including UHC Link, BCBS, and Aetna.
• Electronic Health Record (EHR) and Practice Management systems.
• Healthcare clearinghouse platforms.
• Based in the United States.
• Strong analytical, organizational, and communication skills.
• Ability to accurately document and explain operational workflows.

Note

This opportunity focuses on healthcare administrative and operational expertise rather than medical coding or direct clinical care experience.