Non-Physician Admin (CL Funnel)

• Design realistic, complex scenarios from your own practice area.
• Build the supporting records for designed scenarios.
• Author and evaluate healthcare-operations tasks used to train AI agents.
• Initiate, submit and track prior authorizations through payer portals.
• Perform utilization review and management.
• Handle denials and appeals.
• Perform A/R follow-up.
• Manage payment and revenue integrity.
• Perform underpayment recovery.
• Coordinate benefits and secondary billing.
• Manage claims and billing, and full-cycle medical billing.
• Ensure regulatory and compliance adherence, including HIPAA privacy.
• Perform healthcare internal audits.
• Manage claims adjudication, appeals & grievances, benefit configuration, provider network, and utilization management on the payer side.
• Perform coding audits, Clinical Documentation Integrity (CDI), DRG validation, and Health Information Management.
• Manage revenue integrity, charge master (CDM), managed care, and reimbursement analysis.
• Perform practice, clinic, and hospital administration.

• 2+ years of hands-on, recent experience in a healthcare administrative / back-office role, and currently working in one.
• Direct experience with payer portals (Availity, Optum/Change Healthcare, Waystar, Office Ally, or individual payer hubs), EHR / practice-management platforms, encoders and computer-assisted coding tools, and/or clearinghouses.

• Evidence of owning exceptions and disputes, such as owning an appeal or payer dispute end to end, running coding or DRG audits, defending a code assignment through appeal, leading an EHR conversion or payer implementation, writing SOPs or payer-specific workflow documentation, supervising staff, or sitting on a denials or audit committee.
• Senior-level experience within any competency.
• Experience across two or more care settings.
• Experience on both the provider and payer side.
• US payer knowledge is a plus.

RequiredAlso useful

Project and contracting process: the hiring partner. Applications continue on the provider's website.