Healthcare Administrative Specialist

Document and map the day to day administrative and operational workflows that keep medical practices, hospitals, and health plans running. You will show, in the actual systems you use, the step by step processes for patient intake, authorizations, claims movement, payment posting, provider and payer operations, and medical records administration.

• Capture detailed, real world procedures for one or more back office functions using the exact tools and portals you use each day.
• Map end to end workflows across patient access, prior authorization, claims and revenue cycle, remittance and payment posting, provider and payer operations, and health information administration.
• Demonstrate how tasks are performed inside payer portals, EHR or practice management systems, clearinghouses, and payer-specific hubs, including where work typically starts, common decision points, and how exceptions are handled.
• Provide concrete examples of interactions with payers, providers, and internal teams during intake, authorizations, denials and appeals, reconciliation, credentialing, and release of information.

• Patient access and front end, including registration, scheduling, insurance and eligibility verification, benefits interpretation, intake, and referral management.
• Prior authorizations and utilization support, including initiating, submitting, and tracking authorizations through payer portals.
• Claims and revenue cycle, including claim submission, status tracking, denials and appeals, accounts receivable follow up, and rejection resolution.
• Remittance and payment posting, including electronic remittance advice, payment posting, and reconciliation against clinical charges.
• Provider and payer operations, including credentialing, provider enrollment, payer configuration, appeals and grievances, and member and provider services.
• Health information and practice administration, including medical records administration, release of information, and daily practice operations.

• Minimum 3 years of daily, hands on experience in healthcare administrative or back office roles.
• Current employment in a healthcare administrative role, actively performing the work you would document.
• Direct experience with the systems that run these workflows, for example payer portals such as Availity, Optum or Change Healthcare, Waystar, Office Ally, or payer specific hubs like UHC Link, BCBS, and Aetna, plus experience with EHR or practice management platforms and/or clearinghouses.
• Proven ownership of one or more of the core workflows listed above, with the ability to show step by step procedures in production tools.

• Practice Administrator or Medical Office Manager
• Revenue Cycle Specialist or RCM Analyst
• Medical Billing Coordinator or Full Cycle Biller
• Patient Access Lead, Intake, or Referral Coordinator
• Prior Authorization Specialist
• Denials or Claims Resolution Specialist
• Credentialing or Provider Enrollment Specialist
• Health Plan or Payer Operations staff focused on claims, appeals and grievances, or provider configuration
• Health Information Management or Medical Records Administrator

• Location: Remote
• Employment type: Hourly

• Pay rate: $40.00 to $50.00 per hour

• Must be based in the United States.
• Must currently be working in a healthcare administrative role and able to demonstrate current, hands on experience.

• This role is focused on administrative and operational workflow expertise in healthcare, not on medical coding or clinical care tasks.