Care Operations Specialist

Leap

39d•Remote

About The Position

The Care Operations Specialist supports the operational workflows that enable Leap’s clinical team to deliver high-quality member care. This role owns key administrative processes that ensure clinical operations are ready to activate members for treatment, including benefits verification, prior authorization tracking, provider coordination, and documentation management. By ensuring these processes are completed accurately and on time, the Care Operations Specialist helps enable timely member activation and a smooth care experience. You will work closely with Care Guides, clinical leadership, pharmacy partners, provider offices, and payers to coordinate the information required for treatment readiness. This role reports to the Care Guide Clinical Manager.

Requirements

2+ years of experience in a healthcare administrative or operations role supporting prior authorization or eligibility verification processes
Familiarity with payer portals, prior authorization documentation workflows, and follow-up or appeal processes
Proficiency with CRM or EHR systems and document management platforms including fax
Proven ability to manage high volumes of administrative tasks with accuracy and attention to detail.
Comfortable coordinating across provider offices, payers, pharmacy partners, and internal clinical teams
Strong organizational and communication skills in a fast-paced operational environment
Ability to work independently during CST business hours in a fully remote setting.

Nice To Haves

Clinical certification or licensure (CMA, RMA, CPhT, LPN, or similar)
Experience in a healthcare startup or high-growth environment
Experience in specialty infusion, home infusion, or rare disease programs
Spanish language fluency (spoken and written).

Responsibilities

Prior Authorization & Eligibility Operations
Track and manage prior authorization requests, renewals, and extensions across payers and specialty pharmacy partners
Prepare and submit prior authorization documentation and monitor approval status
Verify member eligibility and benefits to confirm coverage requirements for care initiation
Maintain accurate records of authorization and eligibility status within Leap’s CRM/EHR systems
Provider Coordination
Contact provider offices to obtain updated orders and clarify documentation requirements
Track outstanding provider requests and follow up proactively to prevent delays in care
Coordinate communication between provider offices, specialty pharmacies, and Leap’s clinical team
Documentation & Operational Support
Upload, organize, and maintain member records and clinical documentation accurately and in a timely manner
Process incoming referrals, faxes, and documentation and route materials to the appropriate care team members
Ensure documentation meets internal standards and HIPAA compliance requirements
Inbound Call Support
Answer inbound calls from providers, pharmacy partners, and occasionally members and route inquiries appropriately
Document call details and ensure timely follow-through on related action items
Represent Leap with professionalism and a service-oriented approach during all interactions