Operations Specialist MN
Role 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.
Key Skills for This Role
Full Job Posting
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
CBH1
About Community Based Care
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