Operations Expert

Availity delivers revenue cycle and related business solutions for health care professionals who want to build healthy, thriving organizations. With powerful tools, actionable insights, and expansive network reach, we help medical businesses navigate an industry constantly redefined by change. As a leading healthcare engagement platform, we connect over 2 million providers to health plans and process more than 13 billion transactions annually, driving innovation and efficiency across the healthcare ecosystem.

About the role

Traditional payment integrity solutions identify errors after claims have 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 is not available for this position. Location: Remote, US.

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.

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.

Preferred Qualifications

• 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.

Benefits

• Competitive salary and bonus structure.
• Generous HSA company contribution, healthcare, vision, and dental benefits.
• 401k match program available from day one.
• Unlimited PTO for salaried associates; hourly associates start at 19 days of PTO plus 9 paid holidays.
• Wellness reimbursement up to $250/year for gym memberships, racing events, weight management programs, etc.
• Education reimbursement for furthering your education.
• Paid Parental Leave for both birth and adoptive parents.
• Casual dress code (jeans allowed).
• Opportunities to engage in Diversity & Inclusion teams, Young Professionals Group, and She Can Code IT group for women in tech.
• Community engagement through volunteer opportunities and partnerships with local and national organizations.

Schedule

This is a remote-first role. Video participation is required for all virtual meetings to foster collaboration, engagement, and security. Availity provides camera/video capability for all associates.