UM Product Operations Analyst (Remote) at Availity

, , United States -

Full Time

Start Date

Immediate

Expiry Date

22 Aug, 26

Salary

0.0

Posted On

24 May, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Utilization Management, AI/NLP Model Testing, Advanced Excel, Software Testing, CPT Coding, ICD-10-CM Coding, Medical Terminology, Bug Tracking, EMR, Data Management, Prior Authorization Workflows, Stakeholder Communication, Critical Thinking, Problem Solving, Test Case Development, Clinical Data Analysis

Industry

IT Services and IT Consulting

Description

Availity delivers revenue cycle and related business solutions for health care professionals who want to build healthy, thriving organizations. Availity has the powerful tools, actionable insights and expansive network reach that medical businesses need to get an edge in an industry constantly redefined by change. At Availity, we're not just another Healthcare Technology company; we're pioneers reshaping the future of healthcare! With our headquarters in vibrant Jacksonville, FL, and an exciting office in Bangalore, India, along with an exceptional remote workforce across the United States, we're a global team united by a powerful mission. We're on a mission to bring the focus back to what truly matters – patient care. As the leading healthcare engagement platform, we're the heartbeat of an industry that impacts millions. With over 2 million providers connected to health plans, and processing over 12 billion transactions annually, our influence is continually expanding. Join our energetic, dynamic, and forward-thinking team where your ideas are celebrated, innovation is encouraged, and every contribution counts. We're transforming the healthcare landscape, solving communication challenges, and creating connections that empower the nation's premier healthcare ecosystem. In this role, you will support and help advance an AI-enabled utilization management (UM) solution that automates and modernizes the prior authorization process for healthcare organizations. The solution is designed to ensure clinical accuracy, regulatory compliance, and operational efficiency by translating complex clinical and payer requirements into structured, scalable logic. The UM Product Operations Analyst manages payer and clinical data, supports software testing, and drives process improvements. You will play a key role in collaborating across departments to ensure operational excellence. A unique aspect of this position is supporting the testing and evaluation of AI capabilities, specifically Natural Language Processing (NLP) models that leverage clinical concepts. You will help validate model outputs, contribute to annotation and test case development, and provide feedback to improve AI-driven solutions in the healthcare domain. Sponsorship, in any form, is not available for this position. Location: Remote, US Why you want to work on this team: • Passionate about doing meaningful impact work in healthcare by helping modernize prior authorization and reducing administrative burden so providers can focus more on patient care. • Be part of cutting-edge innovation at the intersection of healthcare, AI, and operations, supporting solutions that use NLP and automation to solve complex industry challenges. • Enjoys taking ownership and drive improvement in a role that values initiative, critical thinking, and process optimization. To be qualified for this position you have: • Undergraduate degree is preferable, but applicable experience in a health care setting will be strongly considered in lieu of a degree.. • Prior relevant experience in healthcare or utilization management strongly preferred. • Experience with AI/NLP model testing or annotation is a plus. • Advanced proficiency in Excel and general computer skills (Microsoft Office suite). • Ability to create and execute test strategies, plans, and cases. • Experience with bug tracking systems and EMRs is a plus. • Familiarity with CPT and ICD-10-CM coding, Medicare/Medicaid, and NCD/LCD is beneficial. • Strong knowledge of healthcare and medical terminology. • Excellent problem-solving, critical thinking, and attention to detail. • Ability to work independently and as part of a team. • Organized, able to multitask, responsible, and proactive. • Open to giving and receiving feedback. • Strong written and verbal communication skills, including the ability to communicate complex technical issues to internal and external stakeholders. • Comfortable with ambiguity and able to design organized approaches to address challenges. • Ability to take on meaningful responsibility and thrive with limited supervision. You will set yourself apart with: • Deep experience in understanding prior auth workflows. • Client-facing or stakeholder communication experience. • Advanced Excel Skills What you will be doing: Data Management & Testing • Transferring payer and clinical data into internal software systems. • Creating and executing test strategies, plans, and cases for software and AI/NLP features including creating, maintaining and overseeing customer implementation plans for tree creation. • Documenting defects using a bug tracking system, test for data accuracy, and participate in quality audits to maintain high standards of technical rigor. • Reviewing accounts, documenting activity, and ensuring compliance with production goals. AI/NLP Model Support • Collaborating with product and engineering teams to test and validate NLP models using clinical concepts. • Developing and executing annotation guidelines and test cases for AI features based on complexity and categorization of impact based on products affected. • Analyzing model outputs, identifying errors, and providing actionable feedback for model improvement. This includes collaboration with cross-functional teams including engineering, clinical and data science teams to prioritize and understand the impact of products affected. • Staying current with clinical terminology and best practices in healthcare AI. Project Leadership & Process Improvement • Taking initiative on assigned tasks and special projects with minimal supervision. • Organizing and prioritizing requests, both internal and external, to help meet established deadlines and often in the context of multiple competing priorities. • Contributing to process improvement, proactively identifying opportunities to enhance workflows and drive team effectiveness. • Collaborating with cross-functional teams from clinical, engineering, product, and data science to plan and execute the product roadmap. Technical & General Support • Providing technical support to team members and leads. • Responding to questions promptly and escalate issues as appropriate. • Supporting and guiding others to ensure project/process accuracy. Availity culture and benefits: • Availity is a certified “Great Place to Work”! Culture is important to us and there are many ways for you to make your mark here! • We have several Culture teams, a Young Professionals Group, and various ways to engage with fellow Availity associates – if you’re near Jacksonville, we have lots of pop up lunches where lunch is provided for everyone when we can see meetings are taking place and we’ve got teams in the office. • Availity is a culture of continuous learning. We have many resources and experts in our tech stack and in our industry that can help get you there too! • Don’t feel like wearing business attire? Cool, you can wear jeans – we are a casual place. • We offer a competitive salary, bonus structure, generous HSA company contribution, healthcare, vision, dental benefits and a 401k match program that you can take advantage of on day one! • We offer unlimited PTO for salaried associates + 9 paid holidays. Hourly associates start at 19 days of PTO and go up from there with all the same holiday benefits. • Interested in wellness? We allow our associates to reimburse up to $250/year for gym memberships, participation in racing events, weight management programs, etc. • Interested in furthering your education? We offer education reimbursement! • Availity offers Paid Parental Leave for both moms and dads, both birth parents and adoptive parents. • Want to work for an organization that gives back to the community? You’re at the right place! Availity partners with various organizations, both locally and nationally, to raise awareness, funds and morale as our staff members volunteer their time and funds to engage the organizations campaign. Next steps: After you apply, you will receive text/email messages thanking you for applying and then you will continue to receive more text/email messages alerting you as to where you are in the recruitment process. Interview process: • Recruiter Recorded Video Pre-Screen • Video Interview with Hiring Manager • Video Panel Interview At Availity, we're not just another Healthcare Technology company; we're pioneers reshaping the future of healthcare! With our headquarters in vibrant Jacksonville, FL, and an exciting office in Bangalore, India, along with an exceptional remote workforce across the United States, we're a global team united by a powerful mission. We're on a mission to bring the focus back to what truly matters – patient care. As the leading healthcare engagement platform, we're the heartbeat of an industry that impacts millions. With over 2 million providers connected to health plans, and processing over 12 billion transactions annually, our influence is continually expanding. Join our energetic, dynamic, and forward-thinking team where your ideas are celebrated, innovation is encouraged, and every contribution counts. We're transforming the healthcare landscape, solving communication challenges, and creating connections that empower the nation's premier healthcare ecosystem. In this role, you will support and help advance an AI-enabled utilization management (UM) solution that automates and modernizes the prior authorization process for healthcare organizations. The solution is designed to ensure clinical accuracy, regulatory compliance, and operational efficiency by translating complex clinical and payer requirements into structured, scalable logic. The UM Product Operations Analyst manages payer and clinical data, supports software testing, and drives process improvements. You will play a key role in collaborating across departments to ensure operational excellence. A unique aspect of this position is supporting the testing and evaluation of AI capabilities, specifically Natural Language Processing (NLP) models that leverage clinical concepts. You will help validate model outputs, contribute to annotation and test case development, and provide feedback to improve AI-driven solutions in the healthcare domain. Sponsorship, in any form, is not available for this position. Location: Remote, US Why you want to work on this team: Passionate about doing meaningful impact work in healthcare by helping modernize prior authorization and reducing administrative burden so providers can focus more on patient care. Be part of cutting-edge innovation at the intersection of healthcare, AI, and operations, supporting solutions that use NLP and automation to solve complex industry challenges. Enjoys taking ownership and drive improvement in a role that values initiative, critical thinking, and process optimization. To be qualified for this position you have: Undergraduate degree is preferable, but applicable experience in a health care setting will be strongly considered in lieu of a degree.. Prior relevant experience in healthcare or utilization management strongly preferred. Experience with AI/NLP model testing or annotation is a plus. Advanced proficiency in Excel and general computer skills (Microsoft Office suite). Ability to create and execute test strategies, plans, and cases. Experience with bug tracking systems and EMRs is a plus. Familiarity with CPT and ICD-10-CM coding, Medicare/Medicaid, and NCD/LCD is beneficial. Strong knowledge of healthcare and medical terminology. Excellent problem-solving, critical thinking, and attention to detail. Ability to work independently and as part of a team. Organized, able to multitask, responsible, and proactive. Open to giving and receiving feedback. Strong written and verbal communication skills, including the ability to communicate complex technical issues to internal and external stakeholders. Comfortable with ambiguity and able to design organized approaches to address challenges. Ability to take on meaningful responsibility and thrive with limited supervision. You will set yourself apart with: Deep experience in understanding prior auth workflows. Client-facing or stakeholder communication experience. Advanced Excel Skills What you will be doing: Data Management & Testing Transferring payer and clinical data into internal software systems. Creating and executing test strategies, plans, and cases for software and AI/NLP features including creating, maintaining and overseeing customer implementation plans for tree creation. Documenting defects using a bug tracking system, test for data accuracy, and participate in quality audits to maintain high standards of technical rigor. Reviewing accounts, documenting activity, and ensuring compliance with production goals. AI/NLP Model Support Collaborating with product and engineering teams to test and validate NLP models using clinical concepts. Developing and executing annotation guidelines and test cases for AI features based on complexity and categorization of impact based on products affected. Analyzing model outputs, identifying errors, and providing actionable feedback for model improvement. This includes collaboration with cross-functional teams including engineering, clinical and data science teams to prioritize and understand the impact of products affected. Staying current with clinical terminology and best practices in healthcare AI. Project Leadership & Process Improvement Taking initiative on assigned tasks and special projects with minimal supervision. Organizing and prioritizing requests, both internal and external, to help meet established deadlines and often in the context of multiple competing priorities. Contributing to process improvement, proactively identifying opportunities to enhance workflows and drive team effectiveness. Collaborating with cross-functional teams from clinical, engineering, product, and data science to plan and execute the product roadmap. Technical & General Support Providing technical support to team members and leads. Responding to questions promptly and escalate issues as appropriate. Supporting and guiding others to ensure project/process accuracy. Availity culture and benefits: Availity is a certified “Great Place to Work”! Culture is important to us and there are many ways for you to make your mark here! We have several Culture teams, a Young Professionals Group, and various ways to engage with fellow Availity associates – if you’re near Jacksonville, we have lots of pop up lunches where lunch is provided for everyone when we can see meetings are taking place and we’ve got teams in the office. Availity is a culture of continuous learning. We have many resources and experts in our tech stack and in our industry that can help get you there too! Don’t feel like wearing business attire? Cool, you can wear jeans – we are a casual place. We offer a competitive salary, bonus structure, generous HSA company contribution, healthcare, vision, dental benefits and a 401k match program that you can take advantage of on day one! We offer unlimited PTO for salaried associates + 9 paid holidays. Hourly associates start at 19 days of PTO and go up from there with all the same holiday benefits. Interested in wellness? We allow our associates to reimburse up to $250/year for gym memberships, participation in racing events, weight management programs, etc. Interested in furthering your education? We offer education reimbursement! Availity offers Paid Parental Leave for both moms and dads, both birth parents and adoptive parents. Want to work for an organization that gives back to the community? You’re at the right place! Availity partners with various organizations, both locally and nationally, to raise awareness, funds and morale as our staff members volunteer their time and funds to engage the organizations campaign. Next steps: After you apply, you will receive text/email messages thanking you for applying and then you will continue to receive more text/email messages alerting you as to where you are in the recruitment process. Interview process: Recruiter Recorded Video Pre-Screen Video Interview with Hiring Manager Video Panel Interview Video Camera Usage: Availity fosters a collaborative and open culture where communication and engagement are central to our success. As a remote first company, we are also camera-first and provide all associates with camera/video capability to simulate the office environment. If you are not able to use your camera for all virtual meetings, you should not apply for this role. Having cameras on helps create a more connected, interactive, and productive environment, allowing teams to communicate more effectively and build stronger working relationships. The usage of cameras also enhances security and protects sensitive company information. Video participation is required to ensure that only authorized personnel are present in meetings and to prevent unauthorized access, data breaches, preventing social engineering, or the sharing of confidential information with non-participants. Disclaimers: Availity is an equal opportunity employer and makes decisions in employment matters without regard to race, religious creed, color, age, sex, sexual orientation, gender identity, gender expression, genetic information, national origin, religion, marital status, medical condition, disability, military service, pregnancy, childbirth and related medical conditions, or any other classification protected by federal, state, and local laws and ordinances. Availity is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. NOTICE: Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States. When required by state law or federal regulation, Availity uses I-9, Employment Eligibility Verification in conjunction with E-Verify to determine employment eligibility. Learn more about E-Verify at http://www.dhs.gov/e-verify. Click the links below to view Federal Employment Notices. Family & Medical Leave Act Equal Employment Law Poster Pay Transparency Employee Polygraph Protection Act IER Right to Work Poster Important Notice about Employee Rights to Organize and Bargain Collectively with Their Employers We love what we do. More importantly, we love where we do it. If you enjoy talented, positive people who are dedicated to working together to create awesome products and solutions, then Availity is the place for you. The work is challenging but the rewards run deep, as do the opportunities for growth. Come make your mark in a place where you will love what you do.

Responsibilities

Manage payer and clinical data while supporting the testing and validation of AI-enabled utilization management and NLP models. Collaborate with cross-functional teams to drive process improvements and execute the product roadmap for prior authorization automation.