Care Operations Specialist

📋 Description

• • Leap Technologies, Inc. is at the forefront of revolutionizing specialty pharmacy and benefits solutions, aiming to transform how life-changing therapies are accessed and financed. As a pioneer in this rapidly evolving sector, Leap is dedicated to ensuring patients receive the treatments they need while providing employers with a more equitable and cost-effective approach to managing healthcare expenses. Specialty drugs and infusions constitute a significant and rapidly growing portion of healthcare expenditure for employers, and Leap is actively addressing this challenge through innovative strategies. Our model focuses on eliminating hidden markups, broadening access to high-quality infusion providers, and bringing unprecedented transparency and fairness to therapy pricing and payment.
• • We are proud to collaborate with a distinguished roster of Fortune 500 companies and leading Third-Party Administrators (TPAs), delivering tangible ROI for every patient served through reduced costs, enhanced access, and improved care outcomes. Joining Leap means becoming part of a mission-driven organization that is redefining the possibilities within specialty care and making a profound difference in patients' lives.
• • The Care Operations Specialist plays a pivotal role in supporting the intricate operational workflows that underpin the delivery of high-quality member care by Leap’s clinical team. This position is instrumental in managing and executing key administrative processes essential for the seamless activation of members for treatment. The core responsibilities encompass meticulous benefits verification, diligent prior authorization tracking, effective provider coordination, and comprehensive documentation management. By ensuring these critical processes are executed with precision and within established timelines, the Care Operations Specialist directly contributes to enabling timely member activation and fostering an exceptionally smooth and positive care experience for all patients.
• • In this dynamic role, you will collaborate extensively with a diverse group of stakeholders, including Care Guides, clinical leadership, esteemed pharmacy partners, various provider offices, and insurance payers. Your primary objective will be to meticulously coordinate the collection and management of all necessary information required to ensure treatment readiness. This position reports directly to the Care Guide Clinical Manager, offering a clear line of reporting and opportunities for mentorship and professional development within a supportive leadership structure.
• • **Prior Authorization & Eligibility Operations:** A significant aspect of this role involves the proactive tracking and comprehensive management of prior authorization requests, including renewals and extensions, across a wide spectrum of payers and specialty pharmacy partners. You will be responsible for preparing and submitting all requisite prior authorization documentation, diligently monitoring its approval status, and maintaining an up-to-date record of all authorization and eligibility statuses within Leap’s sophisticated CRM/EHR systems. Furthermore, you will conduct thorough verification of member eligibility and benefits to confirm coverage requirements are met before care initiation, ensuring a clear path forward for treatment.
• • **Provider Coordination:** This function requires proactive engagement with provider offices to secure updated orders and obtain clarification on specific documentation requirements. You will be tasked with tracking all outstanding provider requests, initiating proactive follow-ups to preemptively address and prevent any potential delays in patient care. A key responsibility is to facilitate seamless communication and coordination between provider offices, specialty pharmacies, and Leap’s internal clinical team, acting as a central point of contact to ensure all parties are aligned.
• • **Documentation & Operational Support:** The Care Operations Specialist will be responsible for the accurate and timely uploading, organization, and meticulous maintenance of member records and all associated clinical documentation. This includes efficiently processing incoming referrals, faxes, and other critical documentation, ensuring materials are promptly routed to the appropriate care team members for review and action. A critical element is ensuring all documentation adheres to internal quality standards and strictly complies with HIPAA regulations, safeguarding patient privacy and data integrity.
• • **Inbound Call Support:** You will serve as a key point of contact by answering inbound calls from a variety of sources, including provider offices, pharmacy partners, and occasionally members themselves, ensuring all inquiries are appropriately directed and addressed. A crucial part of this responsibility is to meticulously document all call details and ensure timely follow-through on any action items that arise from these interactions. Throughout all communications, you will represent Leap with the utmost professionalism and a consistently service-oriented approach, embodying the company’s commitment to excellence in patient care.