Healthcare Outcomes Performance Co. (HOPCo)

Authorization Specialist

• Monitor authorizations for upcoming surgical cases on physicians’ calendars
• Ensure surgery authorizations are obtained accurately and on time
• Verify patient demographic information and insurance eligibility, including coordination of benefits
• Update and confirm information needed for claims processing
• Complete surgical cost analysis forms and document required cost estimates for collection before services
• Verify benefits for all surgical procedures
• Document authorization status and progress in patient charts and case management
• Provide ongoing staff training and education regarding new processes
• Work with the department manager to respond to and reduce complaints
• Assist surgery schedulers with STAT authorizations
• Identify opportunities to improve daily workflow processes
• Attend department meetings as required
• Communicate with physicians, patients, coworkers, management, providers, and internal and external customers

Surgical Authorization Specialist

• Monitor authorizations of upcoming surgical cases on physicians’ calendars
• Ensure surgery authorizations are obtained accurately and on time
• Verify patient demographics, insurance eligibility, and coordination of benefits
• Update information needed for claims processing
• Complete surgical cost analysis forms and document cost estimates for collection before services
• Verify benefits for surgical procedures
• Document authorization progress in patient charts and case management
• Provide ongoing staff training and education on new processes
• Work with the department manager to address and reduce complaints
• Assist surgery schedulers with STAT authorizations
• Maintain confidentiality of health records and member information in accordance with HIPAA
• Identify workflow improvement opportunities
• Attend department meetings as required

Patient Care

• Assist with overseeing daily inbound calls, fax referrals, emails, and department tasks
• Assist Care Managers with assigned tasks
• Continuously monitor patient care through assessment and evaluation to ensure progress toward desired outcomes
• Identify and resolve barriers hindering effective patient care
• Improve the quality and completeness of documentation
• Collaborate with patients, families, nurses, physicians, and other team members
• Build consensus around issues and resolve them appropriately and promptly
• Document clearly, completely, concisely, and in an organized manner
• Monitor clinically low-risk cases
• Advise the Care Manager and/or Medical Director of new or concerning clinical issues
• Institute necessary actions to promote quality and appropriate care
• Accept referrals and identify patients meeting care-management criteria
• Support team members in exhibiting HOPCo’s values and mission
• Assist with program planning, development, and evaluation
• Perform related and other assigned CIN duties

Patient Care Navigator

• Oversee daily inbound calls, fax referrals, emails, and department tasks
• Assist Care Managers with assigned tasks
• Monitor patient care through assessment and evaluation to ensure progress toward desired outcomes
• Identify and resolve barriers to effective patient care
• Improve the quality and completeness of documentation
• Collaborate with patients, families, nurses, physicians, and other team members
• Document clearly, completely, concisely, and in an organized manner
• Monitor clinically low-risk cases
• Advise the Care Manager and/or Medical Director of new or concerning clinical issues
• Institute necessary actions to promote quality and appropriate care
• Accept referrals and identify patients meeting care-management criteria
• Support HOPCo’s values and mission
• Assist with program planning, development, and evaluation
• Perform related and other CIN duties as assigned

Systems Engineer

• Serve as the senior escalation point for infrastructure, identity, and platform issues
• Drive complex, multi-system issues to root cause
• Design, build, and maintain Windows Server, virtualization, storage, and Azure infrastructure
• Translate requirements into designs, build documents, configuration standards, and reference patterns
• Evaluate emerging technologies and provide written recommendations
• Perform capacity analysis, lifecycle planning, and growth forecasting
• Administer Active Directory, Entra ID, Group Policy, conditional access, and privileged access configurations
• Design and maintain Azure subscriptions, networking, compute, storage, and governance controls
• Engineer and maintain Microsoft 365 workloads including Exchange Online, SharePoint, Teams, Intune, and Purview
• Maintain tenant separation, delegation models, and administrative boundaries in a multi-client environment
• Design, implement, and test backup, replication, and disaster recovery
• Harden systems, remediate vulnerabilities and configuration drift, and maintain patching, monitoring, alerting, and logging
• Produce HIPAA, HITRUST, and SOC 2 technical documentation and control artifacts
• Participate in infrastructure and security incident response, root cause analysis, and corrective action
• Execute changes through formal change management with risk assessment, testing, rollback planning, and validation
• Support major incidents outside business hours through an on-call rotation
• Automate administrative and deployment work using PowerShell and infrastructure-as-code tooling
• Build and maintain runbooks, build documents, as-built records, and infrastructure diagrams
• Provide technical direction and mentorship without direct reporting authority
• Partner with Implementation, IT Management, Security, and Applications teams
• Support client-facing technical discussions requiring senior infrastructure expertise

Senior Systems Engineer

• Serve as the senior escalation point for infrastructure, identity, and platform issues
• Drive complex issues to root cause through advanced troubleshooting
• Design, build, and maintain Windows Server, virtualization, storage, and Azure infrastructure
• Translate requirements into detailed designs, build documents, configuration standards, and reference patterns
• Evaluate emerging technologies and make written recommendations
• Perform capacity analysis, lifecycle planning, and growth and refresh forecasting
• Contribute to reference architectures, technical standards, and architecture review submissions
• Administer and engineer Active Directory, Entra ID, Group Policy, conditional access, and privileged access configurations
• Design and maintain Azure subscriptions, networking, compute, storage, and governance controls
• Engineer and maintain Microsoft 365 workloads including Exchange Online, SharePoint, Teams, Intune, and Purview
• Maintain tenant separation, delegation models, and administrative boundaries in a multi-client environment
• Design, implement, and test backup, replication, and disaster recovery
• Harden systems, remediate vulnerabilities and configuration drift, and maintain patching, monitoring, alerting, and logging
• Produce technical documentation and control artifacts supporting HIPAA, HITRUST, and SOC 2
• Participate in infrastructure and security incident response, root cause analysis, and corrective action
• Execute changes through formal change management with risk assessment, testing, rollback planning, and post-change validation
• Support major incidents outside business hours as part of an on-call rotation
• Automate administrative and deployment work using PowerShell and infrastructure-as-code tooling
• Build and maintain runbooks, build documents, as-built records, and infrastructure diagrams
• Reduce manual effort and configuration variance through standardization and tooling
• Provide technical direction and mentorship without direct reporting authority
• Review designs and proposed changes
• Partner with implementation, IT management, security, and applications teams
• Support client-facing technical discussions
• Work occasionally in data centers and network closets and perform limited regional and national travel

Insurance

• Review insurance denials to determine and take the next appropriate action steps to receive payment from the payor
• Appeal claims denied for no authorization, medical necessity, and other reasons
• Verify receipt of claims with insurance plans to ensure timely reimbursement
• Reduce insurance accounts receivable by working through outstanding accounts
• Communicate with payors through phone calls, emails, and payor portals
• Process and take action on written correspondence from insurance payors
• Identify and trend reasons for claim denials
• Resolve claim discrepancies reported by patients and other clinical departments

Insurance Follow-Up Representative

Accounts Receivable

• Perform timely follow-up on outstanding insurance and patient accounts receivable
• Review accounts for unpaid claims, denials, underpayments, and outstanding balances
• Research and resolve billing and account discrepancies
• Communicate with insurance payers regarding claim status, denials, payments, and outstanding balances
• Work assigned billing and A/R work queues within established departmental timelines
• Follow up on denied and unpaid claims and take appropriate action to resolve outstanding balances
• Assist with patient account inquiries and resolve billing-related concerns
• Maintain accurate and thorough documentation of account activity and follow-up
• Research payer requirements and reimbursement guidelines as needed
• Identify and communicate recurring billing or reimbursement issues to leadership
• Maintain confidentiality when handling patient and financial information
• Meet established productivity, quality, and departmental expectations
• Perform other duties as assigned