Operations Expert

This is a fully remote position, open to applicants in United States.

📋 Description

• Act as the main operational contact between clients and the internal Product, Engineering, Clinical, and Operations teams.

• Engage with customers to grasp business priorities, identify core needs, and translate those into technical and operational requirements.

• Coordinate initiatives across multiple functions to deliver new edits, product improvements, and tailored solutions for customers.

• Collaborate with Product and Engineering teams to prioritize tasks and clarify requirements.

• Manage client communications and provide updates regarding edit progress, issue resolution, and timelines for enhancements.

• Assist in EDI file automation by analyzing mapping failures, troubleshooting issues, coordinating remediation efforts, and ensuring compliance with SLA standards.

• Configure, maintain, and troubleshoot edit profiles, routing logic, and translation workflows.

• Work with claims, eligibility, and business stakeholders to design and implement technical edit solutions.

• Develop and maintain technical documentation, testing scenarios, implementation guides, and operational support procedures.

• Identify opportunities to standardize and scale operational processes, influencing reusable platform capabilities across products.

• Monitor operational performance, detect trends, and propose process improvements.

• Support Availity Payment Accuracy, which verifies healthcare claims at submission to minimize denials, administrative burdens, provider abrasion, and healthcare costs.

⛳️ Requirements

• Minimum of 4 years of experience in the healthcare industry, ideally with claims processing, EDI transactions, or payment operations.

• At least 2 years of experience in Payment Integrity, with a solid understanding of payment integrity products, workflows, and business processes.

• Proven experience collaborating with Product, Engineering, Architecture, and Delivery teams in a cross-functional setting.

• Capability to convert customer and business needs into technical solutions and actionable outcomes.

• Experience in leading or supporting enterprise operational transformation initiatives.

• Familiarity with provider workflows, claims adjudication, payment operations, and healthcare business processes.

• Strong analytical, communication, and stakeholder management abilities, with the capacity to influence both technical and business teams.

• Preferred experience in software development, systems implementation, or delivering technical solutions.

• Preferred background in working with healthcare EDI transactions (837, 835, 270/271, etc.).

• Familiarity with healthcare payer operations and payment integrity technologies is preferred.

• Experience managing complex implementations involving multiple cross-functional stakeholders is preferred.

• No sponsorship of any form is available.

• Must pass a drug test prior to starting employment.

• Must be eligible to work in the United States.

• Must have the capability 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 from day one.

• Unlimited PTO for salaried associates.

• 9 paid holidays.

• Wellness reimbursement of up to $250 per year for gym memberships, racing events, weight management programs, etc.

• Education reimbursement.

• Paid parental leave for both birth and adoptive parents.

• Diversity & Inclusion teams.

• Young Professionals Group.

• She Can Code IT group for women in tech.

• Continuous learning resources and access to industry/technology experts.

• Casual dress code allowing jeans.

• Remote-first work environment.

• Camera/video capability required for virtual meetings.