Healthcare Operations Specialist (US-based Healthcare Tech)

Work Arrangement: Monday - Friday, 9 AM - 6 PM PST (with flexibility for urgent needs)

Job Type: Full-time, Independent Contractor.

Salary Range: Very competitive - based on experience

Work Schedule: 40 hours per week, Monday–Friday.

Locations: Remote, open to candidates who can work EST hours.

About Pearl Talent:

Pearl works with the top 1% of candidates from around the world and connects them with the best startups in the US and EU. Our clients have raised over $5B in aggregate and are backed by companies like OpenAI, a16z, and Founders Fund. They’re looking for the sharpest, hungriest candidates who they can consistently promote and work with over many years. Candidates we’ve hired have been flown out to the US and EU to work with their clients, and even promoted to roles that match folks onshore in the US.

Why Work with Us?

We mean when we say that we’re building a different recruiting company here. We only work with exceptional founders from the US and EU who care about the long-term success of their team members. We also provide you with attainable 3, 6, 9, 12 months, and beyond retention bonuses in addition to community-oriented opportunities like an annual retreat.About Pearl Talent:

Pearl works with the top 1% of candidates from around the world and connects them with the best startups in the US and EU. Our clients have raised over $5B in aggregate and are backed by companies like OpenAI, a16z, and Founders Fund. They’re looking for the sharpest, hungriest candidates who they can consistently promote and work with over many years. Candidates we’ve hired have been flown out to the US and EU to work with their clients, and even promoted to roles that match folks onshore in the US.

About the Partner Company:

Our partners are revolutionizing healthcare operations with their HIPAA-compliant AI assistant, designed to automate and streamline the administrative workload for healthcare providers. Their AI technology saves hours of paperwork each week by summarizing parent interviews, caregiver trainings, and RBT supervisions, extracting insights from client records, and generating major sections of treatment plans.

Role Overview:

We’re looking for a Healthcare Operations Associate to own key workflows that power the clinics on our platform. You’ll be on the front lines of ensuring families get approved, schedules run smoothly, and providers get paid. If you’re organized, detail-obsessed, and want to be part of transforming autism care, we want to hear from you.

Key Responsibilities

• Denial Management: Track, investigate, and resolve denied claims to ensure maximum reimbursement.
• State Medicaid EVV Management: Monitor and troubleshoot Electronic Visit Verification (EVV) compliance across multiple state systems.
• Credentialing & Contracting: Submit forms, follow up with payers, and escalate issues to ensure providers are enrolled and contracted quickly.
• Schedule Management: Help clinicians stay productive and compliant by managing weekly therapy schedules and ensuring authorized hours are delivered.
• Verification of Benefits (VOBs): Confirm insurance coverage and benefits with payers, and communicate details clearly to both families and providers.
• Prior Authorizations: Prepare and submit prior authorization requests, and follow up to ensure timely approvals.

Week 1 Ownership:

• 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.

Requirements

Non-Negotiables:

• 2+ years of experience in healthcare operations, revenue cycle, or ABA administration preferred
• Experience with Medicaid, EVV platforms, or insurance credentialing is a strong plus
• 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

Nice-to-Haves:

• 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

Our Recruitment Process:

1. Application
2. Screening
3. Top-grading interview
4. Skills Assessment
5. Client Interview
6. Job Offer
7. Client Onboarding