Care Operations Associate

🕒 il y a 1 mois

🇺🇸 États-Unis – Télétravail

💵 $51 000 - $63 000 / an

⏰ Temps Plein

🟢 Junior

🟡 Intermédiaire

⚙️ Opérations

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Leap

Site WebLinkedInTous les Emplois

11 - 50 employés

Fondée en 2023

🛡️ Assurance

💼 Conseil

🏥 Santé

💰 €1 000 000 Venture Round - LEAP HEALTH en 2024-03

Insurance • Consulting • Healthcare

Leap est la seule solution transparente de gestion des prestations d’infusion spécialisée pour les employeurs. Elle élimine les majorations cachées sur les médicaments et offre une coordination complète des soins d’infusion spécialisés, depuis l'approvisionnement pharmaceutique jusqu'aux soins infirmiers à domicile, afin de réduire les coûts des médicaments spécialisés et de simplifier l'expérience du patient. Leap dessert les employeurs autofinancés, les courtiers/consultants et les patients avec un modèle de soins activé par la technologie qui réduit les dépenses d'infusion, améliore l'engagement et offre des économies substantielles dès l'année en cours.

Description

• Run benefit eligibility checks to confirm coverage, cost-share, and authorization requirements before care begins • Keep eligibility status accurate and current for every active member in our systems • Manage medical prior authorization requests, renewals, and extensions across payers and specialty pharmacy partners end to end • Prepare and submit PA documentation, track approval status, and escalate stalled or denied authorizations before they delay care • Chase down unsigned documents and orders—following up proactively with provider offices so nothing stalls in limbo • Process incoming referrals, faxes, and clinical documents, routing each to the right place • Coordinate clinical staffing with staffing agencies to ensure providers are in place for each member's treatment • Coordinate medication shipping with pharmacy partners so the right therapy arrives at the right time • Answer inbound calls from providers, pharmacy partners, and occasionally members, triaging and routing each inquiry to the right team member • Document call details accurately and follow through on any action items • Collect, organize, and store member records and clinical documentation accurately and on time • Ensure all files meet internal standards and HIPAA compliance requirements • Design, document, and continuously improve the workflows behind all of the above—turning manual, ad hoc tasks into repeatable systems as we scale

🎯 Exigences

• 2+ years in a healthcare administrative or operations role supporting prior authorization or eligibility verification • Familiarity with payer portals, PA workflows, and follow-up/appeal processes • Proficiency with CRM or EHR systems and document management platforms, including fax • A proven track record managing high volumes of detailed work without dropping the ball • Comfort coordinating across provider offices, payers, pharmacy partners, staffing agencies, and internal teams • Strong organizational and communication skills, and the ability to work independently during CST business hours in a fully remote setting

🏖️ Avantages

• Competitive salary • Fully remote • Competitive health, dental, and vision coverage • 401(k) retirement plan • A rare chance to build operational infrastructure from the ground up at a fast-growing company where your work directly gets patients into treatment