[Hiring] Healthcare Administrative Specialist @the Opportunity

Role Description

We’re looking for experienced healthcare administrative and back-office professionals who understand the operational work that keeps medical practices, hospitals, health plans, and healthcare organizations running. In this role, you’ll use your hands-on experience to design realistic, complex healthcare operations scenarios, build supporting records, and author and evaluate tasks used to train and improve AI systems.

This is expert judgment and scenario-authoring work—not high-volume processing.

Priority Areas

• Medical Coding: inpatient, outpatient, professional-fee coding, risk adjustment/HCC coding, and coding audits
• Prior Authorization & Utilization: initiating, submitting, and tracking authorizations through payer portals; utilization review and management
• Revenue Cycle Operations: denials and appeals, accounts receivable follow-up, payment and revenue integrity, underpayment recovery, coordination of benefits, and secondary billing

Additional Areas of Expertise

• Claims and billing
• Full-cycle medical billing
• Regulatory and compliance operations
• HIPAA privacy
• Healthcare internal audit
• Payer-side claims adjudication
• Appeals and grievances
• Benefit configuration
• Provider networks
• Utilization management
• Coding audit
• Clinical Documentation Integrity (CDI)
• DRG validation
• Health Information Management
• Revenue integrity
• Charge master (CDM)
• Managed care and reimbursement analysis
• Practice, clinic, and hospital administration
• Revenue Cycle leadership at the Director or VP level

What You’ll Do

• Design realistic, complicated healthcare administrative and operational scenarios based on your professional experience.
• Build supporting records and documentation needed to make scenarios realistic and complete.
• Author healthcare operations tasks for AI training and evaluation.
• Review AI-generated work for accuracy, completeness, operational realism, and appropriate judgment.
• Evaluate complex exceptions, disputes, workflows, and operational decisions within your area of expertise.
• Provide clear reasoning and expert feedback that can be used to improve AI systems.

Who Should Apply

• Strong candidates are professionals who have owned complex healthcare operational problems, rather than simply processed routine volume.
• Examples of valuable experience include:
• Managing a payer appeal or dispute from initiation through resolution
• Conducting coding or DRG audits
• Defending a code assignment through an appeal
• Leading an EHR conversion or payer implementation
• Writing SOPs or payer-specific workflow documentation
• Supervising healthcare administrative teams
• Participating in denials, compliance, or audit committees
• Managing complex revenue cycle or payer-related exceptions
• Experience spanning two or more healthcare settings, or experience working on both the provider and payer sides, is particularly relevant.

Healthcare Settings

• Hospitals and health systems
• Physician groups and ambulatory practices
• Ambulatory surgery centers
• Skilled nursing and long-term care
• Home health and hospice
• Behavioral health
• Dialysis
• Infusion and specialty pharmacy
• Retail pharmacy and PBM prior authorization
• DME suppliers
• FQHCs
• IDD and waiver services
• Health plans and TPAs
• RCM organizations and clearinghouses

Requirements

• 3+ years of recent, hands-on experience in a healthcare administrative or back-office role
• Currently working in a relevant healthcare administrative, operational, payer, coding, revenue cycle, compliance, or related role
• Direct experience with the systems and workflows used in your area of expertise, such as:
• Payer portals including Availity, Optum/Change Healthcare, Waystar, Office Ally, or individual payer hubs
• EHR and practice-management platforms
• Encoders and computer-assisted coding tools
• Claims clearinghouses
• Ability to commit at least 15 hours per week
• Strong written communication and ability to explain complex operational decisions clearly

Location

• The primary market is the United States, with opportunities also open to qualified professionals in:
• Canada
• United Kingdom
• Ireland
• Continental Europe
• Australia
• New Zealand
• Professionals outside the United States should have hands-on experience with their own country's insurance, funding, billing, or healthcare administration systems. U.S. payer knowledge is helpful but is not required for candidates working within other healthcare systems.

Not in Scope

This opportunity is focused specifically on healthcare administration and back-office operations. It does not include:

• RN, LPN, NP, PA, physician, or other direct clinical care roles
• Pharmacists
• EMTs or paramedics
• Laboratory, radiology, surgical, pharmacy, sterile-processing, respiratory, or phlebotomy technicians
• Reception and front-desk check-in
• Patient registration
• Appointment scheduling or appointment management
• Call-center script-following roles
• Medical scribes
• Transcription-only roles

Work Arrangement

• Fully remote
• Independent contractor
• Flexible schedule, subject to project requirements
• Minimum commitment of 15 hours per week
• Projects may be extended, shortened, or concluded early depending on project needs and performance
• Work will not require access to confidential or proprietary information from an employer, client, or institution
• Payments are made weekly through Stripe or Wise based on services rendered
• H-1B and STEM OPT candidates are not supported for this opportunity

Why This Opportunity

This is an opportunity to apply real-world expertise in healthcare administration, medical coding, payer operations, utilization management, revenue cycle, compliance, health information management, and related workflows to the development and evaluation of advanced AI systems. If your experience comes from solving exceptions, managing disputes, interpreting complex workflows, auditing work, or making operational decisions—not simply processing volume—your expertise can directly inform how AI systems understand healthcare operations.

Skills

• Healthcare Administration
• Medical Coding
• Prior Authorization
• Utilization Management
• Revenue Cycle Operations
• Compliance
• HIPAA Privacy
• AI Scenario Authoring
• Clinical Documentation Integrity
• DRG Validation