CARE SPECIALIST JOB DESCRIPTION

Patients navigate coverage denials, missed aftercare appointments, and gaps between discharge and re-engagement every day. The Care Specialist addresses each of these breakdowns directly. This role owns a defined patient caseload, managing everything from ADL eligibility assessments and insurance coordination to aftercare follow-up under HIPAA and applicable state behavioral health regulations. Four things distinguish it from adjacent titles: the caseload is individually assigned, the documentation obligation runs to the electronic health record within prescribed timelines, reimbursement expertise is a core competency, and patient contact spans community, clinical, and payer channels simultaneously.

As the Care Specialist, you serve as the primary point of contact for patients across the continuum from initial intake and care planning through post-discharge follow-up, ensuring continuous access to services and that insurance coverage, documentation, and referral obligations are met. You operate within a multidisciplinary team, coordinating with physicians, insurance companies, pharmacies, and community partners while maintaining case records that satisfy both contractual standards and clinical compliance requirements.

Career Impact: Hands-on management of insurance reimbursement workflows, ICD-10 coding, and benefit authorization builds a credential set that is recognized across DME, pharma patient services, and behavioral health settings, supporting advancement toward Care Coordinator or Case Manager roles.

Business Impact: Patients who receive timely reimbursement support, coordinated transportation, and structured aftercare follow-up are measurably less likely to experience treatment gaps or avoidable readmissions, directly improving outcomes on the caseload you own.

Growth Opportunity: Exposure across payer types - Medicare, Medicaid, and private insurance - alongside documentation in electronic health record systems positions you to move into utilization review, managed care coordination, or supervisory case management within two to four years.

• Conduct intake assessments and develop individualized care plans in collaboration with patients, caregivers, and multidisciplinary team members.
• Coordinate insurance authorizations, benefits assignments, prescriptions, and Certificates of Medical Necessity to maintain uninterrupted patient access to services.
• Manage aftercare follow-up for discharged patients, tracking missed appointments, transportation barriers, and re-engagement status until treatment continuity is confirmed.
• Process authorization denials through formal appeal or facilitate peer-to-peer review with attending physicians to overturn coverage decisions.
• Document all patient contacts, progress notes, assessments, and service units in the electronic health record within required timelines and per applicable contractual standards.
• Refer patients to community resources, respite services, and supplemental programs based on assessed need and funding source eligibility.
• Collaborate with clinical supervisors, community partners, and payer representatives to resolve coverage gaps and escalate complex cases appropriately.
• Ensure annual caseload goals, required assessment counts, and service unit targets are met in accordance with contracting agency and funding source requirements.

• Bachelor's degree in social work, psychology, counseling, gerontology, health administration, or equivalent work experience.
• 2 or more years of care coordination, case management, or patient services experience, with direct exposure to insurance reimbursement or clinical documentation.
• Working knowledge of Medicare, Medicaid, and private insurance reimbursement processes, including authorization and denial workflows.
• Demonstrated understanding of HIPAA requirements and the handling of protected health information in a clinical or administrative setting.
• Ability to maintain accurate, timely records in electronic health record or case management database systems.
• Strong organizational and time management skills, with the ability to manage a high-volume individual caseload under competing deadlines.
• Clear verbal and written communication skills, with demonstrated ability to interact professionally with patients, families, physicians, and payers.
• Valid driver's license with a clean driving record, and ability to meet physical requirements including periodic patient transport or home visit demands.

• ICD-10 coding knowledge or prior billing and intake experience in a DME or home health environment.
• Bilingual fluency, particularly in a language spoken by the primary patient population served.
• Experience in a behavioral health, disability services, or pharma patient support setting.
• Familiarity with Medicaid waiver programs, ADL eligibility criteria, or managed care contracting structures.

• Caseload documentation compliance rate, measuring the percentage of records entered within required timelines.
• Authorization approval rate on first submission, reflecting reimbursement coordination accuracy across the assigned payer mix.
• Aftercare re-engagement rate within 30 days of discharge, tracking successful patient follow-through on post-hospitalization plans.
• Denial overturn rate via appeal or peer-to-peer review, attributable to this specialist's case preparation and escalation work.
• Annual caseload goal attainment percentage, covering required assessment counts and contracted service unit targets.
• Typical tools: Case management and EHR platforms (commonly STARS, Netsmart, or equivalent); CRM systems (commonly Salesforce or similar).

• Base Salary Range: $38,000 to $54,000 annually, varying by healthcare subsector and region
• Bonus: Modest annual performance bonus; not universal across employers in this sector
• Equity: Typically not offered at this level in healthcare services organizations
• Health Benefits: Medical, dental, and vision coverage; employer contribution varies by organization size
• PTO: 15 to 20 days annually, plus standard federal holidays; some employers offer additional sick leave
• Common Perks: Mileage reimbursement for field visits, continuing education support, EAP access

Figures are estimates based on general US market benchmarks and may be outdated. Adjust based on location, company size, and seniority level.

Background checks and, where applicable, drug screening are a standard condition of employment for roles involving direct patient contact, and offers are contingent on successful completion. All applicants will receive equal consideration without regard to race, color, religion, sex, national origin, age, disability, veteran status, genetic information, or any other characteristic protected under federal, state, or local law. Reasonable accommodations are available to individuals with disabilities throughout the application and employment process upon request. Candidates must be legally authorized to work in the United States.

The Care Specialist delivers end-to-end insurance coverage management, handling Medicare, Medicaid, and private insurance submissions, authorization appeals, and equipment coordination for patient caseloads. Reporting to office leadership, this role supports a healthcare or DME setting and enables uninterrupted patient access to equipment and services through accurate documentation and timely follow-up.

Key Responsibilities

• Work with internal and external customers to make sure insurance coverage guidelines are met.
• Create and file orders to submit to Medicare, Medicaid, and private insurance companies.
• Assist in the smooth flow of paperwork and information within the office.
• Request assignment of benefits, prescriptions, CMNs, letters of medical necessity, and other required information, and follow up on the collection of required documentation.
• Process authorization denials through appeal or facilitate Peer to Peer with Physicians as needed.
• Coordinate the delivery, set-up, and pick up of equipment, supplies, and services.
• Input and update client progress notes, including doctor, diagnosis, and insurance updates.

Required Qualifications

• High school diploma or equivalent required.
• Healthcare or DME experience preferred.
• 2 to 3 years of customer service experience, with 1 to 3 years of billing and intake experience preferred.
• General understanding of ICD-10 coding and insurance reimbursement implications.
• Knowledge of HIPAA and PHI confidentiality requirements.
• Proficient working knowledge of MS Office Suite.
• Strong verbal and written communication skills.
• Excellent organizational and time management abilities.

Embedded within the customer service team, the Care Specialist handles all inbound inquiries across telephone, chat, email, and additional channels, diagnosing issues and delivering solutions in line with established procedures. Working closely with cross-functional teams, this role supports a print products and services environment and sustains customer satisfaction and operational quality metrics.

Core Functions

• Answer all customer inquiries through various channels (telephone, chat, email, and additional channels) courteously and professionally.
• Perform accurate diagnosis of customer inquiries and promptly provide appropriate solutions based on defined procedures.
• Provide continuous feedback to identify customer challenges and reduce effort.
• Participate in cross-functional activities to ensure continued viability and performance of the company.
• Meet and exceed efficiency and quality metrics while adhering to assigned work schedule.
• Educate customers on how to use products and services to market and grow their businesses.
• Use appropriate systems and available resources to assist in responding to each request.

Qualifications & Experience

• Secondary level education with certification in English, Mathematics, or Principles of Accounts, plus any three other subjects required.
• Previous experience in a multi-channel customer service environment preferred.
• Knowledge of and interest in internet and web technologies and social media.
• Experience using graphic design software is an asset.
• Strong verbal and written communication skills with a keen eye for detail.
• Highly motivated, able to multitask effectively, and able to function in a fast-paced, ever-changing environment.
• Availability to work any shift within 24/7 operating hours required.

Reporting to the program team, the Care Specialist shapes care plan development and in-home assessments for elderly and diverse populations, collaborating with caregivers, community partners, and seniors to implement individualized service plans. Partnering with agency staff and external service providers, this role advances equitable access to community-based support and ensures contractual goals, case documentation standards, and service unit targets are consistently met.

Primary Duties

• Conduct intake assessments and develop care plans in collaboration with caregivers and care receivers.
• Conduct in-home assessments to determine ADL eligibility and refer to appropriate services.
• Work with team, community partners, and seniors and families to implement plans of care.
• Ensure annual contractual goals, assessments, and service units are attained and that case notes adhere to agency and professional standards.
• Maintain accurate written and electronic client records and enter data into databases in a timely manner.
• Implement and coordinate supplemental and respite services as determined by assessment and care plan.
• Assist in planning educational workshops and support groups, and participate in case conferences and staff meetings.

Skills & Qualifications

• Bachelor's degree in social work, psychology, counseling, gerontology, education, or related field required; Master's degree preferred.
• Minimum 2  years of full-time work experience in casework, facilitation, and direct practice.
• Demonstrated knowledge of social theories, practices, and core competencies of the social work profession, including sensitivity to the needs of elderly populations.
• Committed to diversity and ability to work with diverse populations of seniors, volunteers, and staff.
• Experience with data management systems required, with STARS experience desirable.
• Highly organized, detail-oriented, and able to manage multiple concurrent projects under tight deadlines.
• Bilingual fluency in an Asian language and English required.

Sitting at the intersection of personal care and clinical documentation, the Direct Care Specialist provides routine assistance with daily living and independent living skills for consumers across a human services program. Operating across care, mobility support, and goal development functions, this role works within a center-based team and ensures that documentation standards and physical care requirements are met for each consumer served.

Duties

• Provide personal care services, including assistance with activities of daily living and independent living skills.
• Assist the activities supervisor with recreational activities as applicable to the program.
• Assist with ambulation and mobility, ranging from total physical assistance with or without adaptive equipment to verbal support.
• Ensure clinical documentation is submitted in accordance with Center standards and meets all designated requirements.
• Assist with consumer assessments and with development of goals and objectives.

Requirements

• High School Diploma or GED, or 6 months of relevant work experience required.
• 6 months of experience in human service care required.
• Must maintain required credentials and mandatory training requirements. 
• Must meet physical requirements to complete SAMA and CPR training, including lifting to 12 lbs. and supporting up to 55 lbs.
• Must have adequate mobility for frequent walking, standing, bending, stooping, kneeling, and reaching, and the ability to lift to 40 lbs. regularly and up to 50 lbs. occasionally.
• A valid driver's license and automobile insurance coverage.

A key member of the funeral home operations team, the Transfer Care Specialist leads the transportation of deceased individuals from hospitals, nursing homes, coroner offices, and residences while managing paperwork, vehicle maintenance, and workflow coordination. Collaborating across driver, attendant, and training functions, this role enables the organization to deliver respectful, compliant, and timely transfer services to families and partner facilities.

Functions

• Transfer the deceased from nursing homes, coroner offices, hospitals, or residences to the funeral home.
• Navigate local roads and highways in varying traffic conditions and at night using GPS or direction apps.
• Receive instructions for multiple tasks, determine the ideal order, and complete them promptly.
• Assist team members by filling in for funeral attendants, covering hearse driving, and supporting onboarding and training of new hires as needed.
• Ensure proper paperwork is completed in a timely manner and in accordance with relevant laws and regulations.
• Interact with customers and family members of the decedent, handling inquiries and directing them according to specific needs.
• Manage deliverables, organize and coordinate workflow, and carry out other assigned duties, including vehicle and equipment maintenance tasks.

Experience & Qualifications

• Knowledge of Microsoft Office Suite (Word, Excel, PowerPoint).
• Strong verbal and written communication skills.
• Ability to follow detailed instructions and apply constructive feedback.
• Ability to maintain composure in challenging situations with compassion and kindness.
• Strong ability to lift more than 100 lbs. safely and maintain professional appearance and dress required.
• Available to work on-call shifts, including nights and weekends as needed.
• Valid state-issued driver's license with a clear driving record required.

Consistent customer retention and product improvement depend on the User Care Specialist, who owns the primary entry point for platform users, resolves issues across support channels, and surfaces customer feedback to Technical, Product, and Customer Success teams. Based within a SaaS-focused support function, this role builds a knowledge base, identifies recurring customer bottlenecks, and drives improvements to the overall customer experience.

Accountabilities

• Serve as the primary entry point for customers facing difficulties on the platform and resolve their issues effectively.
• Collaborate with Technical, Product, and Customer Success teams to deliver the best possible answers in the fastest way.
• Identify repetitive customer bottlenecks and solve them in the most effective manner.
• Provide internal feedback as the voice of the customer to help improve the product.
• Stay up-to-date on product development and latest releases, and contribute to the development of a rich knowledge base.
• Bring in new ideas to improve the customer experience and delight customers.

Technical Qualifications

• Prior experience in a customer-facing role required.
• SaaS environment experience beneficial.
• Curious, quick learner with the ability to absorb large quantities of new information rapidly.
• Strong empathy skills with a genuine desire to help customers.
• Excellent coordination and organizational skills with the ability to multitask efficiently in a fast-paced environment.
• Fluent in German and English with excellent verbal and written communication skills.

As the Senior Care Specialist, this role leads Level 2 through Level 4 remote technical support and root cause analysis for a Nokia Mediation product, delivering code fixes, mentoring team engineers, and ensuring Care quality standards and KPI targets are met. The Care team relies on this work to maintain 24x7 emergency support coverage, uphold SLA compliance, and drive Continuous Excellence initiatives across regional and internal partner teams.

Activities

• Execute Mediation CARE operations and ensure Care quality standards and KPI targets are met.
• Provide remote technical support at Level 2 through Level 4 for the Nokia Mediation product.
• Lead root cause analysis of problems and share all learnings with appropriate stakeholders.
• Perform adaptation and customization code fixes and deliver fixes to customers in this hybrid developer and technical support role.
• Provide technical guidance to Care team engineers to minimize troubleshooting challenges and mentor team members as a subject matter expert.
• Work cooperatively with internal teams and partner with regional Care teams to share and implement best practices.
• Contribute to Continuous Excellence initiatives and provide 24x7 emergency support for critical issues as needed.

Position Requirements

• Bachelor's degree required; Master's degree a plus.
• Minimum 12 years of experience providing highly technical support, services delivery, or software development for complex software applications.
• Minimum 10 years of practical experience with UNIX/Linux scripting, relational databases (Postgres, MariaDB, Oracle RDBMS, Hadoop), and Java, C, Perl, or PL/SQL programming.
• Deep understanding of telecom protocols, including Diameter (Gx, Gy, Sy, Rx) and SOAP.
• Working knowledge of networks, IP, and virtualization and clustering technologies.
• Experience with cloud and virtualization platforms such as OpenStack, Kubernetes, VMware vSphere, AWS, or GCloud, with VNF and CNF knowledge an advantage.
• Customer-first mindset with the ability to work well in a team environment, maintain SLA compliance, and travel for short to medium periods.
• High fluency in oral and written English required.

Personal Care Specialist manages prescription drug coverage, patient onboarding, and reimbursement coordination across an assigned caseload territory within a pharmaceutical patient services program. Success in the position means patients maintain rapid, continuous access to therapy through timely coordination with insurance companies, pharmacies, and healthcare professionals supported by strong case management and analytical skills.

Operational Focus

• Serve as the key point of contact for patients and contact them to gather information and educate them on program services, including injection training, pharmacy options, and reimbursement support.
• Manage all aspects of prescription drug coverage, coordinating initial and renewal prescriptions and maximizing coverage for assigned caseload territory.
• Ensure coordination of patient services in a timely manner to maintain rapid and continuous access to therapy.
• Work collaboratively with team members to coordinate the patient journey and ensure smooth patient onboarding.
• Interact regularly with insurance companies, pharmacies, and healthcare professionals to provide optimal reimbursement support.
• Report adverse events and complete ad hoc duties as assigned.

Knowledge, Skills & Abilities

• Associate degree or post-secondary education, or equivalent combination of experience and education required; Bachelor's degree preferred.
• Experience in a customer service, call center, pharmaceutical, managed care, or third-party reimbursement setting.
• Knowledge of public, private, and federal reimbursement structures.
• Comprehension of medical information.
• Strong Microsoft Office and CRM skills; Salesforce knowledge a plus.
• Exceptional customer service skills.
• Strong project management skills and analytical abilities.
• Strong organizational and time management skills and ability to manage multiple priorities autonomously in a remote setting, with a detail- and result-oriented approach.
• Bilingual in English and French an asset.

The After Care Specialist advances post-discharge continuity for patients leaving area and state hospitals, managing active aftercare lists, follow-up on missed appointments, and transportation coordination within a behavioral health treatment team. Reporting to a supervisor, this role supports patient reengagement in treatment and connects consumers to community resources, with all services documented in the electronic health record within 24 hours.

Key Deliverables

• Process aftercare upon discharge from area and state hospitals in a timely manner and maintain an active list of all aftercare patients with discharge, contact, and appointment details.
• Assess transportation needs and barriers, and assist in providing transportation to support patient aftercare completion.
• Follow up on missed therapy and clinic aftercare appointments and closely monitor patients with more than one past hospitalization until they reengage in treatment.
• Collaborate effectively with treatment team members and provide regular feedback on consumer status, escalating to supervisor as needed.
• Provide information on community resources and document all services in the electronic health record within 24 hours of provision.
• Maintain courteous, respectful, and confidential interactions with consumers, visitors, and co-workers at all times.

Professional Experience

• Minimum high school diploma or equivalent required.
• Knowledge of psychiatric disorders, developmental disabilities, substance use, behavior management, crisis intervention, and cultural diversity in the adult population, to be attained within six months of employment.
• Knowledge of available community resources and internal services.
• Ability to document accurately and on time in an electronic health record system.
• Must participate actively in performance improvement activities, committee work, and required in-service training.
• Valid driver's license with a clear driving record required.