Validate interoperability standards (X12 278, FHIR CRD/DTR/PAS) for transactions between EHRs, Availity, and payer/vendor systems.
Pilot & Launch Oversight: Lead pilots, define KPIs/OKRs, and drive successful go-to-market strategies.
Requirements
experience in Product Management preferably with client facing
experience within healthcare technology.
Deep expertise in prior authorizations workflows.
This is required to be considered for the role.
Strong technical background with an understanding of the CMS 0057-F
Knowledge of EHR systems and utilization management platforms and vendors.
Familiarity with regulatory
Proven ability to lead cross-functional initiatives and influence stakeholders.
Proficiency in analyzing data and finding actionable insights.
Experience with AI-driven utilization management solutions and automation technologies.
Knowledge of the full revenue cycle is a plus.
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! Availity is a culture of continuous learning.
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.
Candidates are required to pass a drug test before beginning employment.
Benefits
Availity delivers revenue cycle and related business solutions for health care professionals who want to build healthy, thriving organizations.
We're transforming the healthcare landscape, solving communication challenges, and creating connections that empower the nation's premier healthcare ecosystem.
What you will be doing: Product Strategy & Vision: Define and communicate a clear product roadmap aligned with CMS requirements, industry trends, and organizational goals.
Stakeholder Communication: Align executives, clients, and internal teams on product vision, progress, and outcomes.
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.
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
Contact
Learn more about E-Verify at http://www.dhs.gov/e-verify .
Additional details
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.
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.
This role will focus on implementing interoperable solutions that streamline prior authorizations, medical necessity reviews, and payer-provider workflows while ensuring compliance with regulatory guidelines.
The ideal candidate will bridge the gap between business and technical teams to optimize prior authorization processes and reporting capabilities.
You will serve as the subject matter expert (SME) for prior authorization workflows and interoperability standards, bridging business and technical teams to deliver innovative solutions that meet CMS mandates and industry needs.
Sponsorship, in any form, is not available for this position.
Why you want to work on this team: Work on cutting-edge solutions that have the potential to reshape prior authorization processes across the healthcare industry.