Operations Specialist

Operations Specialist

Location: Houston, TX (Hybrid) Duration: 3 Months Pay Rate: $30.00 - $33.00/hour (W2)

Work Schedule

• Hybrid work arrangement
• First 3 months: 4 days in office, 1 day remote
• After 3 months: 3 days in office, 2 days remote
• MondayFriday with flexible working hours

Position Summary

Responsible for insurance verification, referral management, pre-certification/pre-authorization, patient scheduling support, claims processing, and maintaining accurate patient and insurance records. Requires strong attention to detail, analytical thinking, and experience in managed care and healthcare operations.

Key Responsibilities

• Complete patient demographic and insurance information accurately in the system.
• Verify insurance eligibility and benefits with insurance providers.
• Obtain and document referrals and referral modifications for specialty care and testing.
• Secure and document pre-certification/pre-authorization numbers prior to procedures and diagnostics.
• Assist with scheduling new patient appointments.
• Create and distribute inpatient and outpatient service lists and manifests to clinical teams.
• Ensure all claims-related data is completed and routed to billing within deadlines.
• Distribute daily admit lists by 1:00 PM and coordinate with pre-certification teams.
• Correct account errors within assigned timelines.
• Maintain communication between physicians, insurance companies, and internal teams regarding authorization status.
• Maintain productivity of 30 authorizations per day with accuracy after onboarding.
• Three days in office after initial onboarding
• Two days remote thereafter

Required Qualifications

• Minimum 2 years of experience in pre-certification or insurance authorization
• Knowledge of managed care processes: referrals, verification, pre-certification
• Understanding of medical terminology
• Familiarity with ICD-9 and ICD-10 coding
• Strong analytical and problem-solving skills
• Excellent attention to detail and accuracy
• Ability to multitask in a fast-paced environment
• Strong communication and organizational skills
• Proficiency in Microsoft Office and Teams
• Accurate data entry skills
• Ability to work occasional overtime when needed