Healthcare Specialist

About the role

We are seeking experienced healthcare operations professionals with hands-on expertise in the administrative and operational workflows that keep medical practices, hospitals, and health plans running efficiently. In this role, you will contribute real-world knowledge of healthcare administration, revenue cycle management, patient access, payer operations, and health information workflows to projects focused on improving next-generation AI systems. No prior AI experience is required—your practical healthcare operations expertise is what matters most.

Responsibilities

• Provide detailed insights into healthcare administrative workflows, systems, processes, and best practices.
• Evaluate and document patient access processes, including registration, scheduling, eligibility verification, benefits interpretation, intake, and referrals.
• Review prior authorization workflows, including submission, tracking, payer communication, and resolution.
• Analyze revenue cycle processes such as claim submission, status tracking, denials, appeals, accounts receivable follow-up, and claim resolution.
• Assess remittance and payment processes, including ERA handling, payment posting, and reconciliation.
• Provide expertise on provider and payer operations, including credentialing, enrollment, payer configuration, appeals, grievances, and member/provider services.
• Review health information and practice administration workflows, including medical records, release of information, and day-to-day office operations.
• Evaluate AI-generated content and workflows for accuracy, completeness, and alignment with real-world healthcare administrative practices.
• Document detailed process steps, system interactions, and recommendations to support AI training and evaluation.