Healthcare Operations Specialist - Coding - AI Trainer

About the Role We're looking for professionals with deep, hands-on experience in the administrative and operational work that keeps healthcare organizations running — the "back office" of a medical practice, hospital, or health plan. You'll design realistic, complex scenarios from your own practice area, build the supporting records, then author and evaluate healthcare-operations tasks used to train AI agents. This is authoring and judgment work, not throughput. Priority Areas — we are hiring hardest here Medical Coding: inpatient, outpatient and pro-fee coding, risk adjustment / HCC coding, coding audit Prior Authorization & Utilization: initiating, submitting and tracking authorizations through payer portals; utilization review and management Revenue Cycle Operations: denials and appeals, A/R follow-up, payment and revenue integrity, underpayment recovery, coordination of benefits and secondary billing Also In Scope Claims & billing, and full-cycle medical billing Regulatory & compliance, HIPAA privacy, healthcare internal audit Payer-side operations: claims adjudication, appeals & grievances, benefit configuration, provider network, 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; Director/VP of Revenue Cycle Requirements 2+ years of hands-on, recent experience in a healthcare administrative / back-office role, and currently working in one Direct experience with the systems this work runs on — 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 A 10+ hrs/week commitment What Makes a Strong Candidate We are looking for people who can construct a complicated problem, not people who process volume. The strongest signals are evidence of owning exceptions and disputes: 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. Within any competency we prefer the senior end, and experience across two or more care settings — or on both the provider and payer side — is a strong plus. Settings Not hospitals only. Also 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, and RCM outsourcers and clearinghouses. Location The United States is our primary market. We are also open to candidates in Canada, the United Kingdom, Ireland, continental Europe, Australia and New Zealand. If you are outside the US, you are expected to work in your own country's insurance, funding or billing system — US payer knowledge is a plus, never a requirement. Not In Scope Clinical care roles (RN, LPN, NP, PA, physician, pharmacist), EMTs and paramedics, medical technicians of any kind (laboratory, radiology, surgical, pharmacy, sterile processing, respiratory, phlebotomy), reception and front-desk check-in, patient registration, appointment scheduling and appointment management at any level, call-centre script-following, medical scribes, and transcription-only roles. #J-18808-Ljbffr Mercor