Healthcare Administrative Operations Specialist
About the Role
A structured healthcare operations initiative focused on using experienced administrative professionals to design, document, and evaluate realistic operational scenarios for AI systems. The work emphasizes professional judgment, exception handling, and domain expertise rather than high-volume processing.
This opportunity is ideal for individuals with recent, hands-on experience in healthcare back-office operations, particularly medical coding, prior authorization, utilization management, revenue cycle, claims, compliance, health information management, or payer operations.
The work involves constructing complex healthcare-operations scenarios, developing supporting records, and authoring and evaluating operational tasks. Strong knowledge of applicable healthcare insurance, funding, billing, and administrative systems is critical.
What You'll Do
- Design realistic healthcare administrative and operational scenarios based on professional experience
- Create supporting records and documentation for complex operational workflows
- Author and evaluate healthcare-operations tasks used to train AI agents
- Apply professional judgment to coding, authorization, claims, billing, revenue cycle, or compliance scenarios
- Analyze exceptions, disputes, denials, audits, and other non-routine operational cases
- Document payer-specific, administrative, or operational workflows where applicable
- Evaluate task outputs for accuracy, completeness, and real-world plausibility
Requirements
- 3+ years of recent, hands-on experience in a healthcare administrative or back-office role
- Currently working in a relevant healthcare administrative, operational, coding, billing, payer, or revenue-cycle function
- Direct experience with relevant operational systems, such as payer portals, EHR or practice-management platforms, coding tools, encoders, or clearinghouses
- Ability to construct and assess complex operational problems rather than primarily perform high-volume processing
- Experience working within the applicable insurance, funding, billing, or healthcare administrative system of the candidate's country
- Availability for at least 15 hours per week
- Ability to work independently in a fully remote, self-directed environment
- Strong experience with exceptions, disputes, audits, appeals, implementations, workflow documentation, or operational oversight preferred
- Experience across multiple healthcare settings or both provider- and payer-side operations preferred
- Experience with medical coding, risk adjustment/HCC coding, coding audits, prior authorization, utilization management, denials and appeals, A/R, revenue integrity, coordination of benefits, CDI, DRG validation, or reimbursement analysis preferred
- Experience using AI-assisted tools such as ChatGPT for structured authoring or evaluation preferred
- Must not require access to confidential or proprietary information from an employer, client, or institution
- Must be able to work as an independent contractor
- H-1B and STEM OPT sponsorship/support unavailable