Shared Services Specialist

3 weeks, 1 day ago
Full-time
Junior
Customer and Technical Support

Private Health Management

Private Health Management is a healthcare company that provides complex care management, healthcare navigation, intensive case management, expert physician referrals, research support, and coordinated treatment guidance for people facing serious or complex medical conditions.

Healthcare
201-500
Founded 2007

Description

  • Build working expertise across Provider Network, Partner Benefits, and Medical Records to support all three functions.
  • Research providers, verify credentials, and maintain accurate provider database records and documentation.
  • Conduct provider outreach and respond to provider data quality and operational requests from Care Teams.
  • Research and interpret commercial, employer-sponsored, and Medicare health benefits.
  • Verify insurance coverage and explain benefit information to support Care Teams.
  • Request medical records from provider offices, hospitals, and facilities and follow up on outstanding requests.
  • Document record collection status clearly and accurately and coordinate with Care Teams to prevent delays.
  • Partner across Shared Services to flex between functions based on business demand.
  • Identify workflow improvement opportunities through technology, AI, and process enhancements.

Requirements

  • Bachelor's degree strongly preferred.
  • Strong knowledge of commercial health insurance, employer-sponsored plans, Medicare, and common healthcare benefit concepts.
  • Ability to interpret plan documents and navigate complex healthcare benefit scenarios.
  • Exceptional research and critical thinking skills with the ability to synthesize information from multiple sources.
  • Outstanding attention to detail and a commitment to consistently accurate work.
  • Adaptability, learning agility, and enthusiasm for cross training across multiple healthcare functions.
  • Comfort using technology, AI tools, and multiple systems to improve efficiency and quality.
  • Experience working in a health plan, provider office, hospital, healthcare navigation, care management, or similar healthcare environment (preferred).
  • Familiarity with provider research, credential verification, provider directories, healthcare databases, or medical records collection (preferred).
  • Experience supporting authorizations, referrals, claims, or appeals (preferred).
  • Experience improving workflows through technology, AI, or process enhancements (preferred).
  • Must live in and physically perform all work in the United States.

Benefits

  • Target hourly rate of $26.44–$31.25 per hour.
  • Health, dental, and vision benefits.
  • 401(k) with company match.
  • Paid time off.
  • PHM for PHM services for employees and their dependents.
  • Remote work from anywhere in the United States.

Interested in this position?

Apply directly on the company website

Apply Now

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