Operations Specialist MN

Overview

The Operations Specialist is responsible for executing the branch’s pre-claim review process to ensure all service activity entered in Pavillio is accurate, complete, and ready for billing. This role serves as a critical control point between service delivery and the revenue cycle, proactively identifying and resolving issues that prevent claims from moving forward.

The Operations Specialist works cross-functionally with Client Care, Clinical, Caregivers, and the Revenue Cycle Management (RCM) team to correct errors, resolve documentation gaps, and validate service details prior to claim submission. Success in this role directly supports reducing unbilled services, accelerating cash flow, and improving overall revenue capture for the branch.

Responsibilities

Pre-Claim Review & Billing Readiness

Perform detailed review of service activity in Pavillio prior to claim submission

Identify failed service cards, incomplete records, and discrepancies preventing billing

Validate that all service details are accurate, authorized, and properly documented

Confirm required approvals, signatures, and documentation are present before claims move forward

Issue Resolution & Documentation Follow-Up

Proactively track down missing or incomplete documentation

Coordinate with caregivers, Client Care Coordinators, and Clinical staff to resolve issues quickly

Correct service entry errors and ensure alignment with authorizations and care plans

Monitor unresolved service activity and follow through to timely resolution

Cross-Functional Coordination

Collaborate with branch teams and the RCM team to address billing-related issues

Communicate service activity issues and trends to leadership as needed

Partner with Client Care and Clinical teams to help prevent recurring documentation and entry errors

Process Support & Continuous Improvement

Identify patterns contributing to unbilled services or claim delays

Provide feedback on process improvements to reduce errors and rework

Support consistent service activity and documentation practices across the branch

Qualifications

Key Outcomes & Performance Indicators

Reduction in unbilled and delayed services

Improved first-pass claim acceptance rates

Faster resolution of failed service cards and documentation gaps

Improved revenue capture and cash flow

Qualifications

Strong understanding of pre-claim processes, EVV, and service documentation requirements

High attention to detail with strong problem-solving skills

Ability to work cross-functionally with operational, clinical, and billing teams

Experience identifying and resolving workflow or documentation issues

Comfortable working in fast-paced, high-volume operational environments

Systems & Tools

Pavillio (or similar EVV / service activity platform)

Billing and documentation tracking systems

Reporting tools for service activity and claim readiness

Reporting Structure

Reports to: Operations Leadership / RVP

Works closely with: Client Care, Clinical teams, Caregivers, and Revenue Cycle Management (RCM)

Work Environment

Centralized or branch-based operational role

Highly collaborative, detail-oriented, and outcome-driven

In office position Monday-Friday 8:00am-4:30pm

Pre-Claim Review & Billing Readiness

Perform detailed review of service activity in Pavillio prior to claim submission

Identify failed service cards, incomplete records, and discrepancies preventing billing

Validate that all service details are accurate, authorized, and properly documented

Confirm required approvals, signatures, and documentation are present before claims move forward

Issue Resolution & Documentation Follow-Up

Proactively track down missing or incomplete documentation

Coordinate with caregivers, Client Care Coordinators, and Clinical staff to resolve issues quickly

Correct service entry errors and ensure alignment with authorizations and care plans

Monitor unresolved service activity and follow through to timely resolution

Cross-Functional Coordination

Collaborate with branch teams and the RCM team to address billing-related issues

Communicate service activity issues and trends to leadership as needed

Partner with Client Care and Clinical teams to help prevent recurring documentation and entry errors

Process Support & Continuous Improvement

Identify patterns contributing to unbilled services or claim delays

Provide feedback on process improvements to reduce errors and rework

Support consistent service activity and documentation practices across the branch

Key Outcomes & Performance Indicators

Reduction in unbilled and delayed services

Improved first-pass claim acceptance rates

Faster resolution of failed service cards and documentation gaps

Improved revenue capture and cash flow

Qualifications

Strong understanding of pre-claim processes, EVV, and service documentation requirements

High attention to detail with strong problem-solving skills

Ability to work cross-functionally with operational, clinical, and billing teams

Experience identifying and resolving workflow or documentation issues

Comfortable working in fast-paced, high-volume operational environments

Systems & Tools

Pavillio (or similar EVV / service activity platform)

Billing and documentation tracking systems

Reporting tools for service activity and claim readiness

Reporting Structure

Reports to: Operations Leadership / RVP

Works closely with: Client Care, Clinical teams, Caregivers, and Revenue Cycle Management (RCM)

Work Environment

Centralized or branch-based operational role

Highly collaborative, detail-oriented, and outcome-driven

In office position Monday-Friday 8:00am-4:30pm