Operations Administrator
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Job Description
Operations Administrator assisting with case management and administrative duties in a healthcare environment. Managing documentation, coordinating communications, and ensuring compliance with state regulations.
Responsibilities:
- Accept and process newly assigned review cases.
- Create and maintain case folders within secure document management systems.
- Review incoming documentation and identify enrollee, representative, and health plan contact information.
- Maintain accurate case records and tracking spreadsheets.
- Request missing contact information or documentation from stakeholders as needed.
- Monitor case timelines and ensure compliance with state-specific requirements.
- Organize, upload, rename, and maintain case-related documents for efficient review.
- Create and manage secure ShareFile accounts for health plans, providers, and clinical reviewers.
- Prepare, encrypt, and distribute confidential documents using approved security protocols.
- Assist stakeholders with secure document submission through email, file-sharing platforms, or mail.
- Maintain complete and organized electronic case files throughout the review process.
- Prepare medical reviewer forms and supporting documentation for clinical reviewers.
- Set up and manage secure reviewer access to case materials.
- Distribute reviewer instructions and required forms.
- Track reviewer submissions and ensure all required documentation is received.
- Maintain communication with reviewers regarding administrative requirements.
- Prepare cover letters and final determination mailing packets for all involved parties.
- Assemble state-specific correspondence packages and supporting documentation.
- Coordinate secure electronic distribution and certified mail delivery.
- Maintain tracking records for all mailed and emailed determination packets.
- Archive final case documentation according to organizational procedures.
- Generate invoices based on state-specific fee schedules.
- Distribute invoices to health plans and applicable regulatory entities.
- Monitor invoice due dates and payment status.
- Maintain invoice tracking systems and supporting documentation.
- Send payment reminders and coordinate with finance personnel regarding outstanding payments.
- Ensure adherence to state IRO regulations, confidentiality requirements, and internal procedures.
- Maintain case tracker, monitoring reports, and invoice records.
- Document daily case activity, communications, and phone logs.
- Preserve accurate records for audit and compliance purposes.
- Support project leadership with administrative reporting and operational updates.
Requirements:
- Minimum of high school diploma or GED equivalent required
- 2+ years of experience in administrative operations, healthcare administration, insurance, legal support, or case management.
- Professional demeanor and excellent customer service skills
- Strong proficiency with Microsoft Office Suite, including Excel, Outlook, and Word.
- Experience managing confidential and sensitive information.
- Excellent organization, prioritization, and time-management skills.
- Excellent Communicator with Strong written and verbal communication skills.
- Ability to work independently and manage multiple deadlines simultaneously.
- Exceptional attention to detail and accuracy.
- Thrives working both independently (a self-starter) and collaboratively
- Dependable, respectful and consistently works to uphold company ethics and standards
Benefits:
- Medical, Dental, and Vision benefits available
- 401(k) available with company match
- Paid holidays
- Paid Vacation Time
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