Job Description

Private Health Management guides patients and families through the chaos and complexity of serious medical care, for cancer and beyond. As an independent advocate and trusted partner during healthcare’s most challenging moments, our team of experts work alongside physicians to orchestrate the best treatment, advocacy, and support to deliver measurably better outcomes.

Everyone deserves great care. We make sure they get it.

About the Role

Most healthcare organizations create specialists. PHM develops healthcare problem solvers.

We are hiring two Shared Services Specialists to help build a flexible, cross functional operating model across Partner Benefits , Provider Network , and Medical Records . Rather than working within one narrow specialty, you'll develop expertise across multiple Shared Services functions and flex where Care Teams and the business need support most.

The two hires will begin with different areas of focus. One will initially support Provider Network and Partner Benefits , while the other will initially support Provider Network and Medical Records . Over time, both will cross train into the third function, creating versatile operational specialists who can provide coverage during absences, respond to changing volumes, and help Care Teams and clients get answers faster.

What You'll Accomplish

• Build working expertise across Provider Network , Partner Benefits , and Medical Records , ultimately providing reliable support across all three functions.
• Improve turnaround times for Care Teams by delivering accurate, high quality operational support across multiple service lines.
• Help create a more resilient Shared Services organization by flexing across functions as workloads, absences, and business needs change.
• Become a trusted "quick hitter" who researches thoroughly, completes work accurately, and operates with increasing independence.

How You'll Spend Your Days

Provider Network

• Research providers, verify credentials, and vet providers to ensure our provider database remains accurate and high quality.
• Conduct provider outreach and maintain provider records and documentation.
• Support ongoing provider data quality and operational requests from Care Teams.

Partner Benefits

• Research and interpret commercial, employer sponsored, and Medicare health benefits.
• Verify insurance coverage and explain benefit information to support Care Teams.
• Document findings clearly and consistently while following established SOPs.

Medical Records

• Support medical records collections by requesting records from provider offices, hospitals, and facilities; following up on outstanding requests; and documenting collection status clearly and accurately.
• Coordinate with Care Teams and Medical Records colleagues to help prevent avoidable delays.

Shared Services Operations

• Partner across Shared Services to flex between functions based on business demand.
• Identify opportunities to improve workflows through technology , AI , and process enhancements.
• Contribute to a collaborative, continuously improving operational team.

What You Bring to the Table

Required

• Bachelor's degree strongly preferred.
• Strong knowledge of commercial health insurance, employer sponsored plans, Medicare, and common healthcare benefit concepts, with the ability to interpret plan documents and navigate complex scenarios.
• Exceptional research and critical thinking skills with the ability to synthesize information from multiple sources.
• Outstanding attention to detail and a commitment to consistently accurate work.
• Adaptability, learning agility, and enthusiasm for cross training across multiple healthcare functions.
• Comfort using technology , AI tools , and multiple systems to improve efficiency and quality.

Nice to Have

• Experience working in a health plan, provider office, hospital, healthcare navigation, care management, or similar healthcare environment.
• Familiarity with provider research, credential verification, provider directories, healthcare databases or medical records collection.
• Experience supporting authorizations, referrals, claims, or appeals.
• Experience improving workflows through technology , AI , or process enhancements.

Job Tags

Similar Jobs