Job Description

We are seeking experienced healthcare administrative professionals with deep, hands-on expertise in the operational and back-office functions that keep healthcare organizations running efficiently.

This fully remote opportunity is ideal for individuals who understand the complete administrative lifecycle of healthcare operations—from patient registration and insurance verification to claims management, provider enrollment, and payment reconciliation.

In this role, you'll contribute your real-world expertise to support the development of next-generation AI systems by documenting, evaluating, and improving complex healthcare administrative workflows. Your knowledge of day-to-day operations and industry-standard tools will help build AI solutions that accurately reflect real healthcare environments.

Requirements

Key Responsibilities

Core Workflow Areas

Candidates should have hands-on ownership of one or more of the following operational functions:

Patient Access & Front-End Operations

• Manage patient registration, scheduling, and appointment coordination.
• Perform insurance eligibility verification and benefits interpretation.
• Oversee patient intake and referral management processes.

Prior Authorization & Utilization Management

• Initiate, submit, and monitor prior authorization requests through payer portals.
• Coordinate with providers and insurance companies to ensure timely approvals.

Claims & Revenue Cycle Management

• Submit insurance claims and monitor claim status.
• Investigate denials, manage appeals, and resolve claim rejections.
• Conduct accounts receivable follow-up to ensure timely reimbursement.

Remittance & Payment Processing

• Process Electronic Remittance Advice (ERA).
• Post payments accurately and reconcile remittances with clinical charges.
• Assist in payment reconciliation and financial reporting activities.

Provider & Payer Operations

• Manage provider credentialing and enrollment activities.
• Support payer configuration and maintenance.
• Handle provider and member services, appeals, and grievance processes.

Health Information & Practice Administration

• Administer medical records and release of information requests.
• Support daily medical office and practice administration activities.
• Ensure documentation and operational processes remain compliant with organizational policies.

Required Qualifications

• Minimum 3 years of hands-on experience in a healthcare administrative or back-office operations role.
• Current employment within a healthcare administrative environment.
• Strong working knowledge of industry-standard systems, including:
• Payer portals such as Availity, Optum/Change Healthcare, Waystar, Office Ally , or payer-specific portals including UHC Link, BCBS, and Aetna .
• Electronic Health Record (EHR) and Practice Management systems.
• Healthcare clearinghouse platforms.
• Based in the United States .
• Strong analytical, organizational, and communication skills.
• Ability to accurately document and explain operational workflows.

Ideal Backgrounds

Candidates with experience in any of the following roles are encouraged to apply:

• Practice Administrator
• Medical Office Manager
• Revenue Cycle Specialist
• Revenue Cycle Analyst
• Medical Billing Coordinator
• Full-Cycle Medical Biller
• Patient Access Lead
• Patient Intake Coordinator
• Referral Coordinator
• Prior Authorization Specialist
• Claims Resolution Specialist
• Denials Management Specialist
• Credentialing Specialist
• Provider Enrollment Specialist
• Health Plan Operations Professional
• Payer Operations Specialist
• Appeals & Grievances Specialist
• Provider Configuration Specialist
• Health Information Management (HIM) Professional
• Medical Records Administrator

Note: This opportunity focuses on healthcare administrative and operational expertise rather than medical coding or direct clinical care experience.

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