Operations Specialist

Responsibilities

• Perform detailed review of service activity in Pavillio prior to claim submission
• Identify failed service cards, incomplete records, and discrepancies preventing billing
• Validate that all service details are accurate, authorized, and properly documented
• Confirm required approvals, signatures, and documentation are present before claims move forward

• Proactively track down missing or incomplete documentation
• Coordinate with caregivers, Client Care Coordinators, and Clinical staff to resolve issues quickly
• Correct service entry errors and ensure alignment with authorizations and care plans
• Monitor unresolved service activity and follow through to timely resolution

• Collaborate with branch teams and the RCM team to address billing-related issues
• Communicate service activity issues and trends to leadership as needed
• Partner with Client Care and Clinical teams to help prevent recurring documentation and entry errors

• Identify patterns contributing to unbilled services or claim delays
• Provide feedback on process improvements to reduce errors and rework
• Support consistent service activity and documentation practices across the branch

• Reduction in unbilled and delayed services
• Improved first-pass claim acceptance rates
• Faster resolution of failed service cards and documentation gaps
• Improved revenue capture and cash flow

• Strong understanding of pre-claim processes, EVV, and service documentation requirements
• High attention to detail with strong problem-solving skills
• Ability to work cross-functionally with operational, clinical, and billing teams
• Experience identifying and resolving workflow or documentation issues
• Comfortable working in fast-paced, high-volume operational environments

• HHA (or similar EVV / service activity platform)
• Billing and documentation tracking systems
• Reporting tools for service activity and claim readiness

• Reports to: Operations Leadership / RVP
• Works closely with: Client Care, Clinical teams, Caregivers, and Revenue Cycle Management (RCM)

• Centralized or branch-based operational role
• Highly collaborative, detail-oriented, and outcome-driven