Provider Relations Operations Associate

Alaffia Health

27d

About The Position

As a Payment Integrity Operations Associate, you’ll be at the center of our audit execution and provider communication processes.You will manage the end-to-end audit lifecycle — from document requests and follow-ups to final findings delivery — ensuring every step is timely, compliant, and professional. This is a fast-paced, detail-driven role ideal for someone who loves operations, thrives in a structured environment, and takes pride in excellent communication and customer service. You’ll collaborate closely with clinical reviewers, audit managers, and product teams to ensure seamless provider experiences and efficient audit throughput.

Requirements

4+ years of experience in healthcare operations, provider relations, or audit support (payment integrity, utilization review, claims, or revenue cycle experience preferred)
Excellent written and verbal communication skills — able to write clear, professional correspondence to providers and clients.
Highly organized and comfortable managing multiple concurrent workflows in a fast-paced environment.
Strong sense of accountability and ownership; you take initiative and don’t let details slip.
Exceptionally detail-oriented with a keen eye for accuracy and completeness in documentation, communication, and data entry.
Proficient in Microsoft Office Suite (Excel, Word, Outlook) and Google Workspace (Docs, Sheets); comfortable using formulas, filters, and pivot tables for tracking and reporting.

Nice To Haves

Familiarity with claims auditing, medical record procurement, or health plan operations is a plus.

Responsibilities

Own the audit lifecycle: Track and manage cases from initial document request to final audit finding, ensuring deadlines are met and communication is timely.
Send and follow up on documentation requests: Coordinate with providers to obtain required medical records, maintaining professionalism and persistence in all outreach. Additionally, accessing customer electronic systems to obtain records when needed.
Manage the provider inbox: Monitor incoming provider communications, triage requests, and respond to inquiries within established turnaround times.
Compose and send audit finding letters: Prepare and deliver audit determinations and outcome communications, ensuring clarity and accuracy in all correspondence.
Optimize workflows: Identify process gaps and inefficiencies; create or update SOPs to drive greater consistency, accuracy, and throughput.
Maintain organized documentation: Log all communications, updates, and task completions within internal systems to ensure full audit traceability.
Collaborate cross-functionally: Work closely with clinical auditors, appeal teams, and product teams to resolve issues and ensure smooth handoffs.
Deliver a high-touch provider experience: Represent Alaffia Health professionally in all interactions — balancing compliance with empathy and customer care.