Kareliz Wellness is a Peruvian company committed to delivering high-quality support services to healthcare operations in the United States. We offer stable remote opportunities for professionals who are ready to grow within structured, long-term roles serving leading healthcare organizations.

We are seeking a Bilingual Medicare Patient Services Specialist to provide remote support to a private clinic in California, USA.

This is a full-time, long-term opportunity for a professional with proven experience in U.S. healthcare insurance and patient-facing operations. This role is not campaign-based; it is designed for candidates looking for stability, continuity, and professional growth within a structured healthcare environment.

We are looking for someone with strong judgment, excellent communication skills, and hands-on experience supporting patients, insurance workflows, and internal care coordination processes.

Requirements

- Technical institute or university degree in business, administration, healthcare, or a related field.
- Minimum 2 years of experience in similar roles.
- Solid experience in U.S. health insurance processes.
- Previous experience in U.S. healthcare environments is required.
- Advanced / fluent English, both written and spoken (mandatory).
- Strong communication, organization, and follow-up skills.
- Intermediate Microsoft Office skills.
- Experience with E-Clinical Works (ECW) is highly preferred.
- Ability to work accurately in a fast-paced, metrics-driven environment.
- Reliable remote work setup: computer, stable internet connection, webcam, and headset.
- Professional attire to Represent the company externally

Key Responsibilities

- Manage inbound and outbound calls with patients covered by Medicare, Medi-Cal, Commercial insurance, and Self-Pay.
- Schedule and track appointments, with emphasis on physical exams and Annual Wellness Visits.
- Verify eligibility and benefits across different insurance types.




- Submit medical information through payer systems to support the closure of care gaps.
- Maintain accurate patient demographic, medical, and financial records.
- Support core Medicare and Medi-Cal processes, including scheduling, follow-up, reporting, email handling, internal/external coordination, and ECW documentation review.
- Coordinate with insurance representatives, providers, brokers, and internal teams as needed.
- Contribute to operational goals, quality standards, and performance metrics.
- Ensure confidentiality of patient medical, personal, and financial information.
- Participate in patient growth and brand-support initiatives when required.
- Organize and represent the clinic in video call meetings with representatives, partners, associates (communication skills and professional attire, professionalism)
- Serve as primary point of contact with Medicare Advantage plans, MSOs, and delegated entities
- Submit, track, and follow up on required documentation, reports, and data exchanges with payers.
- Escalate and resolve eligibility, attribution, and claims-related issues with payer representatives.
- Track and report on care gaps, quality measures, and risk adjustment (RAF/HCC) opportunities.
- Coordinate with providers and clinical staff to ensure appropriate documentation supports coding accuracy.
- Monitor completion of Annual Wellness Visits (AWVs) and other value-based care initiatives.
- Identify trends, discrepancies, and revenue leakage opportunities, and escalate findings to leadership.

What We Offer

- 100% remote work
- Stable, long-term position
- Direct support for a California-based clinic
- Opportunity to join a professional and growing international team
- Ongoing training and career development
- Collaborative and performance-driven work environment

Job Type

- Full-time

Schedule

- Monday to Friday, from 10am to 8pm / 11am to 9pm

Language Requirement

- Advanced / Fluent English required

Tipo de puesto: Jornada completa, Permanente Sueldo: A partir de S/.2,300.00 al mes

Idioma

- Inglés avanzado (Obligatorio)

Lugar de trabajo: Empleo remoto

📌 Bilingual Medicare Patient Services Specialist | Remote | California Clinic (Lima)
🏢 KARELIZ WELLNESS LLC
📍 Lima