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Classet

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United Healthcare (UHC) Referral Specialist

Location

Worldwide

Posted

3 days ago

Salary

$16 - $17 / hour

Seniority

Mid Level

No structured requirement data.

Job Description

United Healthcare (UHC) Referral Specialist

Classet

Role Description Chronic Care Staffing is seeking a detail-oriented United Healthcare (UHC) Referral Specialist to support our referral and authorization operations. This role serves as a critical link between patient referrals and insurance approval processes, ensuring that specialist appointments receive the proper authorizations and documentation required for successful scheduling. The ideal candidate has experience working with insurance portals, prior authorizations, medical data entry, or healthcare administration and thrives in a structured, accuracy-focused environment. Responsibilities - Access and navigate the United Healthcare provider portal on a daily basis. - Submit and manage referral authorization requests. - Enter patient diagnoses, provider information, and referral details with a high degree of accuracy. - Verify provider and facility information, including National Provider Identifiers (NPIs). - Utilize internal reference guides, code lists, and portal resources to complete authorization requests. - Secure authorization numbers required for specialist appointments. - Monitor authorization status and update records accordingly. - Ensure referrals meet insurance requirements and compliance standards. - Collaborate with scheduling and follow-up teams to support patient care workflows. - Assist with additional referral coordination tasks as workload demands. Qualifications - 1–2 years of experience in one or more of the following: - Health insurance portal management - Prior authorizations - Medical billing support - Healthcare data entry - Referral coordination - Experience navigating insurance provider websites and online healthcare portals. - Strong data entry skills with exceptional attention to detail. - Ability to accurately process large volumes of information. - Excellent organizational and time-management skills. - Ability to work independently in a remote environment. - Strong computer proficiency and comfort learning new systems. Requirements - Previous experience using United Healthcare (UHC) or UHC Link portals. - Knowledge of prior authorization workflows. - Familiarity with provider credentialing information and NPIs. - Experience working in medical offices, healthcare administration, or referral management. - Understanding of insurance eligibility and referral requirements. Benefits - Fully remote work environment. - Consistent full-time schedule. - Paid training and onboarding. - Career growth opportunities within healthcare operations. - Supportive and collaborative team culture. - Opportunity to directly impact patient access to care. - Stable healthcare administration role with long-term growth potential.

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Contracting and Credentialing Specialist

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Full TimeRemoteTeam 1-10H1B Sponsor

Role Description A US-based healthcare provider organization in the behavioral health space is looking for a Contracting and Credentialing Specialist to own the full lifecycle of provider credentialing and payer contracting. The organization operates within the Applied Behavior Analysis and behavioral health sector, coordinating across multiple insurance payers and provider networks. The team prioritizes clean documentation, compliance, and operational reliability, and is ready to train the right hire on its internal systems and processes. Day-to-day, this role: - Maintains credentialing files - Prepares and tracks credentialing and re-credentialing applications - Reviews and negotiates payer contracts - Resolves enrollment and contracting discrepancies - Provides limited support to billing tasks Success means: - Providers stay fully credentialed - Payer contracts remain current and compliant - The revenue cycle runs free of credentialing-driven delays Qualifications - 2+ years of experience in healthcare contracting, credentialing, or revenue cycle management - Hands-on experience preparing, submitting, and tracking credentialing and re-credentialing applications with insurance payers and networks - Working knowledge of insurance verification, payer enrollment, and provider data management - Experience reviewing, negotiating, and managing payer contracts, including tracking expirations and renewal timelines - Proficiency with credentialing software platforms and Microsoft Office - Familiarity with both payer-side and provider-side healthcare operations - C1+ English (CEFR) for payer communication and contract negotiation Requirements - Experience in Applied Behavior Analysis (ABA) or behavioral health settings - Working knowledge of CAQH, NPI registry, and insurance payer portals - Exposure to medical billing or claims follow-up within a revenue cycle team - Track record of process improvement in credentialing or contracting workflows Benefits - Competitive Salary: Based on experience and skills - Remote Work: Fully remote—work from anywhere - Team Incentives: Recognition for maintaining 100% CRM hygiene and on-time reporting - Generous PTO: In accordance with company policy - Health Coverage for PH-based talents: HMO coverage after 3 months for full-time employees - Direct Mentorship: Guidance from international industry experts - Learning & Development: Ongoing access to resources for professional growth - Global Networking: Connect with professionals worldwide

Latin America (LATAM)
$1.8K / month

Role Description The Fidelity Specialist will conduct all aspects of evidence-based practice (EBP) fidelity reviews conducted by WICHE. WICHE reviews fidelity of EBPs as implemented by community providers in accordance with SAMHSA standardized fidelity tools and state-specific tools. The review process determines providers’ adherence to EBP standards and identifies future support needs of the providers. This position may be based in Phoenix, Arizona (remote), or the Denver Metro area (office located in Boulder, CO). Under the supervision of the Fidelity Review Program Manager, the Fidelity Specialist will be responsible for evaluating providers of four EBPs in Arizona and other states. After undergoing professional training with subject matter experts on the four EBPs and the fidelity review process, the Fidelity Specialist will operate as an integral part of a team and perform all duties required to conduct fidelity reviews and reporting according to the SAMHSA standards, WICHE processes, and state-specific tools. The Specialist will make recommendations for maintaining SAMHSA EBP standards and improving practices to support quality services. The ideal candidate for this position will thrive in a highly collaborative, team-based environment; have exceptional verbal and written communication skills; demonstrate meticulous attention to detail; and be passionate about improving behavioral health services. Duties and Responsibilities - Conduct structured, team-based fidelity reviews using standardized evidence-based practice (EBP) fidelity scales, including chart reviews, interviews, and direct observation. - Analyze fidelity data to determine the extent to which programs adhere to core EBP components and identify strengths and gaps in implementation. - Prepare clear written reports that summarize findings, provide fidelity ratings, and outline specific, actionable recommendations for improvement. - Provide verbal feedback to program leadership and staff to help them interpret results. - Maintain up-to-date expertise in assigned EBPs (e.g., ACT/FACT, COS, PSH, SE), including model standards, emerging research, and best implementation practices. - Inform providers and supervisors on the purpose, process, and expectations of fidelity reviews to promote engagement and transparency. - Ensure fidelity review processes are adhered to and reviews are conducted in an objective and ethical manner, respecting participant and staff confidentiality. - Contribute to the refinement of fidelity tools, procedures, and training materials to improve reliability, validity, and usability across programs and sites. - Review and edit team members’ reports and communication. - Promote a constructive workplace culture within the fidelity review team and throughout the BHP. - Work collaboratively within BHP to conduct other duties as assigned. Qualifications - Bachelor’s degree in a relevant field (such as psychology, counseling, social work, public health, or nursing) from a regionally accredited college or university. - Minimum four years’ direct practice experience serving individuals with a Serious Mental Illness (SMI) OR four years’ experience working in a quality assurance/fidelity review role (e.g., for a community mental health center, health system, or hospital). - High level of professionalism and ability to interact with system partners at all levels (e.g., CEO, Director, practitioner, client). - Exceptional written and verbal communication skills. - Proactively takes initiative and demonstrates strong organizational and time management skills, with a high level of attention to detail and the capacity to effectively manage multiple projects simultaneously. - Advanced interviewing skills. - Demonstrated ability to conduct evaluation in an impartial, objective manner. - Ability to think critically and utilize a solution-focused approach to challenges. - Openness to feedback, and commitment to a continuous learning/quality improvement process. - Computer proficiency, including the ability to use email, Microsoft suite of programs (Word, Excel, PowerPoint) and to effectively navigate electronic health records. Requirements - Master’s degree in a relevant field (such as psychology, counseling, social work, public health, or nursing) from a regionally accredited college or university. - Knowledge of SAMHSA evidence-based practices, specifically Assertive Community Treatment (ACT), Supported Employment (SE), Permanent Supportive Housing (PSH), and Consumer-Operated Services Programs (COSP). - Experience writing quality improvement reports for a behavioral health program. - Industry knowledge of Project Management standards and practices. - Industry knowledge of EBP Fidelity Review standards and practices. - Demonstrated strategies for successful remote work (if applicable). - Lived experience with a behavioral health condition(s). Travel Currently, most EBP fidelity reviews are being conducted virtually. Travel as necessary and requested by clients for on-site fidelity reviews will be required. Additionally, if located in Phoenix, AZ, there may be two or three trips to headquarters in Boulder, Colorado per year. Benefits - WICHE offers a competitive benefits package which includes medical insurance with generous employer contribution to health savings account (H.S.A.), dental, life, and disability insurance. - Flexible spending accounts (medical and dependent care). - 403(b) retirement plan with employer match of 200% on employee contributions up to 5% after six full months of employment. - Vacation accrual, paid family leave, sick leave, paid holidays, and personal leave time.

United States
$68K - $78K / year

Role Description The Contract Specialist provides acquisition support for large-scale design, construction, and transportation projects. This role supports cradle-to-grave contracting functions under the guidance of a federal Contracting Officer, including: - Acquisition planning - Solicitation development - Source selection - Award processing - Contract administration - Closeout Key Responsibilities - Conduct acquisition planning and market research in coordination with project teams and Contracting Officer - Prepare and issue solicitations, amendments, and Requests for Proposals/Quotes - Support source selection activities, cost/price analysis, and negotiation documentation - Draft award packages and distribute final contract documentation - Maintain electronic contract files and resolve payment or wage determination issues - Process contract modifications, evaluate contractor proposals, and document negotiations - Prepare closeout documentation and ensure compliance with FAR, DIAR, and agency policies Qualifications - Completion of an accredited 4-year bachelor’s degree with a major in any field; or - Contracting/Acquisition/Procurement experience of at least 20 years; or - Completion of 24 semester hours in Business in any combination of the following disciplines: accounting, business, finance, law, contracts, purchasing, economics, industrial management, marketing, quantitative methods, or organization and management; and - Possession of Federal Acquisition Certification in Contracting (FAC-C) Professional or equivalent (e.g., DAWIA Level II/III) - A bachelor’s degree in any of the listed business disciplines satisfies both the degree and 24 semester hour requirement when paired with FAC-C Professional or equivalent certification. Requirements - Minimum 5 years of federal contracting experience - Experience with construction and architect-engineer services preferred - Ability to obtain HSPD-12 PIV and pass background/security clearance Systems and Tools - FPDS, PRISM, FBMS, SAM.gov, IPP - Microsoft 365 (Word, Excel, Outlook, Teams) - SharePoint and other agency-specific platforms Work Environment and Compliance - Remote work setup; contractor provides home office equipment - Core hours: 9:00 AM–3:00 PM Mountain Time, Monday–Friday - No work on federal holidays - Contractor personnel must clearly identify as non-government (e.g., email signature, badge, directory listings) - No access to government vehicles, internal HR services, or employee-only events Security and Training Requirements - Completion of IT Security Awareness training upon onboarding and annually - Signed Rules of Behavior and confidentiality agreements - Compliance with Homeland Security Presidential Directive 12 (HSPD-12)

United States
$75K - $90K / year
Volunteers of America National Services (VOANS) logo

Healthcare Regulatory Specialist

Volunteers of America National Services (VOANS)

Senior Community Care of Colorado PACE provides healthcare and supportive services for individuals age 55 and older, helping them live safely, comfortably, and independently in their own homes and communities. As a Program of All-Inclusive Care for the Elderly (PACE) provider and the first of its kind in Western Colorado, our interdisciplinary teams deliver personalized, comprehensive care tailored to each participant’s needs. Located in beautiful Montrose, the community is surrounded by stunning Colorado scenery, including the Black Canyon of the Gunnison National Park to the east and the San Juan Mountains to the south, with easy access to a charming downtown, local dining, and year-round outdoor recreation. At VOANS, we celebrate sharing, encouraging and embracing diversity. Equal employment opportunities are available to all without regard to race, color, religion, sex, pregnancy, national origin, age, physical and mental disability, marital status, parental status, sexual orientation, gender identity, gender expression, genetic information, military and veteran status, and any other characteristic protected by applicable law. We believe that blending individual strengths and unique personal differences nurtures and supports our organizations’ shared commitment to our mission and creates an inclusive and diverse environment where everyone feels valued and has the opportunity to do their personal best.

Role Description Are you passionate about healthcare compliance and ready to make a real impact? VOANS Healthcare is seeking a Healthcare Regulatory Specialist to serve as the division’s go-to expert for all regulatory requirements in PACE and Senior Living programs. Schedule: Monday-Friday 8:00 AM-5:00 PM Location: Fully Remote Salary: $90,000-$100,000 (Based on Experience) Qualifications - Strong ability to create, build, and maintain productive relationships at all levels. - Education: Bachelor’s degree in a healthcare-related field such as Healthcare Administration, Health Services Management, Nursing, Public Health, Health Information Management, or a related discipline required. A Master’s degree is preferred but not required. - Licensure and Certification: Requires a recognized healthcare compliance certification, such as Certified in Healthcare Compliance (CHC) or an equivalent compliance or regulatory credential. - Experience: Requires a minimum of three (3) years of progressively responsible experience in healthcare compliance, regulatory oversight, auditing, or survey management, including direct responsibility for interpreting regulations, supporting audits or surveys, reviewing policies for regulatory alignment, and advising operational or clinical leaders on compliance requirements, preferably in senior care settings such as skilled nursing, assisted living, or PACE. Requirements - Serve as the subject matter expert for federal and state regulations applicable to the assigned business line, including CMS requirements, state licensing rules, and contractual obligations (e.g., PACE three-way agreement). - Provide real-time regulatory consultation to Quality Managers, Clinical Specialists, and program/facility leadership. - Maintain a centralized repository of regulatory interpretations, guidance documents, and standardized decision tools. - Monitor regulatory developments (e.g., CMS memos, state rule changes, federal guidance, association updates). - Produce concise, actionable regulatory summaries for internal distribution. - Conduct impact assessments of regulatory changes and outline required operational, documentation, or workflow adjustments. - Lead planning for compliance with new or revised regulatory requirements, including timelines, responsibilities, and reference materials. - Serve as a primary reviewer of policies and procedures to ensure regulatory accuracy, alignment with federal/state requirements, and internal consistency. - Maintain policy crosswalks linking regulatory citations to internal policies. - Participate in drafting and revising policies based on regulatory changes, survey trends, and audit findings. - Support harmonization of regulatory policy across business lines where appropriate. - Oversee regulatory components of the internal audit workplan and ensure alignment with survey expectations. - Conduct focused regulatory audits based on federal/state requirements, areas of known risk, or prior deficiencies. - Provide documented findings and regulatory interpretations to the Quality Manager and relevant operational leaders. - Assist Quality Managers and leadership in understanding the regulatory significance of identified issues. - Maintain readiness tools, crosswalks, and regulatory expectations to support facilities/programs in anticipating survey focus areas. - Supervise internal auditors and guide their audit work to ensure accuracy, consistency, and regulatory alignment. - Ensure audit tools remain up to date with current regulatory requirements and reflect best practices. - Conduct occasional validation audits (spot checks) to ensure audit integrity and consistency across auditors. - Trend audit findings and prepare reports summarizing regulatory risk patterns, recurring concerns, and opportunities for systemic improvement. - Collaborate with the VP of Compliance and Performance Excellence and Director of Healthcare Compliance on annual audit workplan development. - Provide regulatory interpretation of issues identified through internal audits, incidents, complaints/grievances, survey findings, and operational escalation. - Ensure the regulatory implications of issues are clearly communicated to the Quality Manager and leadership. - Advise on what regulatory standards apply, what outcomes must be achieved, and what the minimum regulatory expectation for resolution looks like. - Collaborate with QMs during the preliminary review of findings to ensure accurate problem definition prior to corrective action planning. - Support leadership awareness of high-risk regulatory trends and systemic vulnerabilities. - Provide training on the regulatory topics most relevant to the assigned business line. - Develop regulatory quick reference guides, checklists, and decision aids for Quality Managers, Clinical Specialists, and operational leaders. - Support onboarding and ongoing competency development for Quality Managers. - Deliver targeted education following regulatory changes or identified gaps. - Serve as regulatory resource for infection control, care planning, accident prevention, abuse/ neglect standards, psychotropic medication regulations, PCC documentation expectations, and MDS compliance (in coordination with MDS Manager). - Support facilities in understanding and implementing survey expectations related to these domains. - Identify regulatory performance indicators suitable for dashboard reporting. - Partner with BI/PBI resources to integrate regulatory metrics into division-wide dashboards. - Provide analysis and regulatory interpretation of trends in incidents, audits, survey results, and compliance indicators. - Promote consistency in regulatory practice across regions and business lines. - Maintain positive working relationships with state regulatory bodies, CMS staff, and provider associations. - Participate in state or regional regulatory meetings, provider forums, or rulemaking sessions as appropriate. - Support strong organizational communication and cross-facility learning. - Actively participate as an engaged member of the Performance Excellence team. - Establish and maintain productive working relationships. - Protect privacy and maintain confidentiality of all company procedures, results, and information about employees, residents, and families. - Participate in continuing education classes and any required staff and training meetings. - Follow all Volunteers of America National Services policies and procedures and Occupational Safety and Health Administration (OSHA) safety guidelines. Benefits - 403(b) Retirement Plan - Career scholarships - Continuing career education and leadership programs - Medical, Dental and Vision Insurance - Paid Time Off (Vacation, Holiday & Sick Days) - NetSpend – Get paid early: Tap into 50% of your earnings before payday

Minnesota
$90K - $100K / year