Health Services Specialist

Make a Difference in Healthcare Are you detail-oriented, organized, and passionate about helping people navigate healthcare? Do you enjoy working with healthcare providers, solving problems, and making sure patients receive timely access to services? Comagine Health is looking for a Health Services Specialist to join our team! Work Location Remote – Washington State This position is designated as remote within Washington State. Candidates must reside in Washington. In this role, you'll support healthcare providers, clinical teams, and members by coordinating service requests, managing healthcare documentation, and helping ensure medical management processes run smoothly. About Comagine Health Comagine Health is a national nonprofit healthcare consulting organization dedicated to improving healthcare quality, access, and outcomes. We collaborate with healthcare providers, health plans, government agencies, and community partners to help create a more effective, equitable, and patient-centered healthcare system. At Comagine Health, your work contributes to something meaningful—helping improve healthcare for the people and communities we serve. What You'll Do As a Health Services Specialist, you'll play an important role in supporting our healthcare operations and ensuring providers and members receive responsive, accurate, and professional service. Your day-to-day responsibilities will include: Support healthcare providers: Assist providers with submitting medical service requests, using online provider portals, understanding documentation requirements, and navigating medical management processes. Process healthcare requests: Receive and coordinate referrals, prior authorization requests, utilization review cases, and case management requests through electronic portals, phone, fax, and other communication channels. Review documentation for accuracy: Verify that service requests are complete and accurate, identify missing medical information, and follow up with providers or other appropriate contacts. Deliver excellent customer service: Answer inbound calls, respond to provider and member questions, document interactions, and help resolve routine inquiries and concerns. Maintain accurate healthcare records: Enter information into electronic healthcare management systems, upload medical documentation, organize case files, and maintain detailed records. Support utilization management: Work alongside clinical reviewers and physicians to process review outcomes, verify determination information, and prepare accurate notification letters. Coordinate care management services: Help schedule assessments, coordinate transportation or accommodation requests, obtain necessary consents, and assist with non-clinical care coordination. Collaborate with clinical teams: Communicate with nurses, physicians, case managers, and other healthcare professionals to support timely processing of requests. Additional responsibilities may include: Completing scripted clinical review screenings and referring cases requiring clinical judgment to qualified clinical staff. Communicating service determinations to providers following physician review, as directed. Supporting quality assurance reviews, training activities, and process improvements. Assisting with case closure and maintaining compliance with program requirements. What We're Looking For Required Qualifications High school diploma or GED. At least 2 years of related work or customer service experience. At least 1 year of experience working in a healthcare setting. Strong written and verbal communication skills. Excellent attention to detail, organization, and follow-through. Ability to manage multiple priorities while maintaining accuracy. Strong customer service skills and a professional, solutions-focused approach. Ability to work collaboratively with healthcare providers, clinical professionals, and team members. Comfort using computers, electronic records, and multiple software applications. Preferred Qualifications 2 or more years of healthcare experience. Experience as a Medical Assistant, Nursing Assistant, Patient Services Representative, Medical Office Specialist, or Healthcare Coordinator. Post-secondary education or certification in healthcare administration or a related field. Familiarity with prior authorizations, utilization management, medical terminology, case management, or insurance processes. Experience working with electronic health records, healthcare portals, or medical management systems. No professional healthcare license is required for this position. What Will Help You Succeed You'll be a great fit if you: Enjoy helping people and delivering exceptional customer service. Are comfortable working in a fast-paced, detail-driven healthcare environment. Take pride in accurate documentation and completing work on time. Can communicate confidently and professionally with providers and team members. Are dependable, adaptable, and comfortable working independently in a remote environment. Appreciate being part of a collaborative team focused on improving healthcare. Why Comagine Health? At Comagine Health, you'll have the opportunity to apply your healthcare experience in a role that supports better care and meaningful outcomes. You'll join a mission-driven organization that values collaboration, professionalism, continuous improvement, and the contributions of its employees. Comagine Health is an equal opportunity employer. We welcome applicants with diverse backgrounds, experiences, and perspectives. Equal employment opportunity, including veterans and individuals with disabilities. #J-18808-Ljbffr Comagine Health