Operations Expert

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

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Availity

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2000

🏥 Healthcare

💼 Consulting

📦 Logistics

💰 Secondary Market on 2021-07

Healthcare • Consulting • Logistics

Availity is a leading health information network that connects payers, providers, and technology partners in the healthcare industry. By facilitating over 13 billion clinical, administrative, and financial transactions annually, Availity streamlines payer-provider collaboration and enhances patient care through an integrated provider engagement platform. The company's solutions leverage artificial intelligence and interoperability to automate processes such as prior authorizations, revenue cycle management, and payment accuracy, ultimately reducing costs and improving efficiency across the healthcare ecosystem.

📋 Description

• Serve as the primary operational liaison between clients and internal Product, Engineering, Clinical, and Operations teams • Meet with customers to understand business priorities, uncover root needs, and translate them into technical and operational requirements • Coordinate cross-functional initiatives to deliver new edits, product enhancements, and customer-specific solutions • Partner with Product and Engineering to prioritize work and clarify requirements • Manage customer communications and provide updates on edit progress, issue resolution, and enhancement timelines • Support EDI file automation by analyzing mapping failures, troubleshooting issues, coordinating remediation, and ensuring SLA compliance • Configure, maintain, and troubleshoot edit profiles, routing logic, and translation workflows • Collaborate with claims, eligibility, and business stakeholders to design and implement technical edit solutions • Prepare and maintain technical documentation, testing scenarios, implementation guides, and operational support procedures • Identify opportunities to standardize and scale operational processes and influence reusable platform capabilities across products • Monitor operational performance, identify trends, and recommend process improvements • Support Availity Payment Accuracy, which validates healthcare claims at submission to reduce denials, administrative burden, provider abrasion, and healthcare costs

🎯 Requirements

• 4+ years of healthcare industry experience, preferably with claims processing, EDI transactions, or payment operations • 2+ years of Payment Integrity experience with a strong understanding of payment integrity products, workflows, and business processes • Experience partnering with Product, Engineering, Architecture, and Delivery teams in a cross-functional environment • Ability to translate customer and business needs into technical solutions and delivered outcomes • Experience leading or supporting enterprise operational transformation initiatives • Knowledge of provider workflows, claims adjudication, payment operations, and healthcare business processes • Strong analytical, communication, and stakeholder management skills, with the ability to influence across technical and business teams • Experience with software development, systems implementation, or technical solution delivery preferred • Experience working with healthcare EDI transactions (837, 835, 270/271, etc.) preferred • Familiarity with healthcare payer operations and payment integrity technologies preferred • Experience managing complex implementations involving multiple cross-functional stakeholders preferred • Sponsorship in any form is not available • Must pass a drug test before beginning employment • Must be eligible to work in the United States • Must be able to use a camera for all virtual meetings

🏖️ Benefits

• Competitive salary • Bonus structure • HSA company contribution • Healthcare benefits • Vision benefits • Dental benefits • 401k match program available on day one • Unlimited PTO for salaried associates • 9 paid holidays • Wellness reimbursement up to $250/year for gym memberships, racing events, weight management programs, etc. • Education reimbursement • Paid parental leave for birth and adoptive parents • Diversity & Inclusion teams • Young Professionals Group • She Can Code IT group for women in tech • Continuous learning resources and industry/technology experts • Casual dress / jeans permitted • Remote-first work environment • Camera/video capability for virtual meetings