Healthcare Operations Specialist

Summary

Join Pearl Talent as a Healthcare Operations Associate and play a vital role in transforming autism care. This full-time, remote independent contractor position offers a competitive salary and flexible hours. You will manage key workflows, ensuring smooth clinic operations, timely reimbursements, and efficient scheduling. Responsibilities include denial management, EVV compliance, credentialing, and prior authorizations. The ideal candidate possesses 2+ years of healthcare operations experience and strong organizational and communication skills. Pearl Talent provides generous benefits, including ample PTO, direct mentorship, professional development opportunities, and a supportive work-life balance.

Requirements

• 2+ years of experience in healthcare operations, revenue cycle, or ABA administration
• Organized, proactive, and comfortable managing multiple priorities
• Clear communicator —both in writing and over the phone
• Mission-driven: passionate about improving autism care for families

Responsibilities

• Track, investigate, and resolve denied claims to ensure maximum reimbursement
• Monitor and troubleshoot Electronic Visit Verification (EVV) compliance across multiple state systems
• Submit forms, follow up with payers, and escalate issues to ensure providers are enrolled and contracted quickly
• Help clinicians stay productive and compliant by managing weekly therapy schedules and ensuring authorized hours are delivered
• Confirm insurance coverage and benefits with payers, and communicate details clearly to both families and providers
• Prepare and submit prior authorization requests, and follow up to ensure timely approvals
• Gain access to core systems (e.g., EMR, EVV platforms, payer portals) and complete onboarding on Alpaca’s operations and support workflows
• Establish daily check-ins or Slack updates with your operations lead to align on priorities, track progress, and flag blockers early
• Shadow ongoing processes across denial management, credentialing, and schedule coordination to understand clinic pain points and high-priority workflows
• Begin a light audit of assigned clinics' operational health—review claims backlog, authorization expirations, and schedule gaps to identify areas needing immediate attention

Preferred Qualifications

• Experience with Medicaid, EVV platforms, or insurance credentialing
• Knowledge of medical coding: Familiarity with HCPCS Level II, ICD-10-CM, and CPT® codes
• Denials management experience: Ability to identify, analyze, and appeal denied claims, while implementing strategies to reduce future denials
• Understanding of the healthcare revenue cycle: Knowledge of how billing, coding, insurance policies, and denials interact within a revenue cycle
• Insurance policy knowledge: Comfortable interpreting EOBs, understanding coverage limits, and pinpointing reasons for claim denials

Benefits

• Remote Work: Fully remote—work from anywhere
• Generous PTO: Ample paid time off to rest and recharge
• Direct Mentorship: Grow through guidance from international industry experts
• Learning & Development: Ongoing access to resources for professional growth
• Global Networking: Work and connect with professionals around the world
• Work-Life Balance: Flexible hours that support a healthy work-life balance
• Attainable 3, 6, 9, 12 months, and beyond retention bonuses
• Community-oriented opportunities like an annual retreat