Operations Expert

Availity

3d • Remote

About The Position

Traditional payment integrity solutions identify errors after claims have already been adjudicated, when denials, appeals, and rework are already underway. Availity Payment Accuracy operates earlier in the claims lifecycle by validating claims at submission—before they enter a health plan’s systems. By resolving issues upstream, we reduce avoidable denials, administrative burden, provider abrasion, and overall healthcare costs.
As an Operations Expert, you will serve as the operational bridge between clients and internal teams, partnering closely with Product, Engineering, and Operations to ensure successful implementation, execution, and ongoing optimization of Payment Accuracy solutions. You will translate customer needs into actionable technical requirements, coordinate cross-functional efforts, and drive operational excellence throughout the product lifecycle.
Sponsorship, in any form, is not available for this position.
Location: Remote, US

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.
• Demonstrated 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.

Nice To Haves

• Experience with software development, systems implementation, or technical solution delivery.
• Experience working with healthcare EDI transactions (837, 835, 270/271, etc.).
• Familiarity with healthcare payer operations and payment integrity technologies.
• Experience managing complex implementations involving multiple cross-functional stakeholders

Responsibilities

• 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 those needs into actionable 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, clarify requirements, and ensure solutions address meaningful customer and business problems.
• Manage customer communications, providing proactive updates on edit progress, issue resolution, and enhancement timelines.
• Support EDI file automation by analyzing mapping failures, troubleshooting issues, coordinating remediation efforts, 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 the development of reusable platform capabilities across multiple products.
• Monitor operational performance, identify trends, and recommend process improvements to enhance customer experience and operational efficiency.

Benefits

• competitive salary
• bonus structure
• generous HSA company contribution
• healthcare
• vision
• dental benefits
• 401k match program
• unlimited PTO for salaried associates
• 9 paid holidays
• 19 days of PTO for hourly associates
• reimbursement up to $250/year for gym memberships, participation in racing events, weight management programs, etc.
• education reimbursement
• Paid Parental Leave for both moms and dads, both birth parents and adoptive parents.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed