Reporting to the VP of Software Engineering, the Medical Director will lead a team of UM RN Analysts responsible for producing Availity’s Auth AI platform.
Specifically, the Medical Director will provide input and oversight of the interpretation of payer medical policy guidelines, the construction of NLP/AI–enabled attestation trees reflective of the medical necessity criteria and clinical validation of the platform.
The role requires an in-depth knowledge of utilization management principles, the purpose and function of medical necessity guidelines and prior authorization adjudication practices.
experience in the healthcare revenue cycle roles including Utilization Management, prior authorization, claims appeals/denials, either with an insurer or with a healthcare provider. Prior
experience working in healthcare information technology and with cross-functional teams, while not essential, will enhance an application.
experience working or interacting with payer medical policy teams including
experience performing peer-to-peer conversations or serving on medical policy committees.
If you are self-motivated and a quick learner with an ability to multi-task.
What you will be doing: Providing oversight and input to the clinical team of UM nurses and prior authorization specialists throughout the product development process from the point of initial review of medical policy through the release of NLP/AI-enabled attestation trees into production.
This entails developing a working knowledge of a domain-specific programming language and use of development tools to assign coded medical constructs to attestation trees to facilitate automation of their responses.
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 on a mission to bring the focus back to what truly matters – patient care.
We're transforming the healthcare landscape, solving communication challenges, and creating connections that empower the nation's premier healthcare ecosystem.
You will set yourself apart: If you have a deep, working knowledge of the healthcare insurance industry and relevant state and federal regulations. If you have
We have many resources and experts in our tech stack and in our industry that can help get you there too! 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.
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Contact
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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 13 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 person will work in a team environment and will be expected to perform complex tasks while collaborating with colleagues with clinical and engineering/programming backgrounds.
Sponsorship, in any form, is not available for this position.
If you have exceptional critical thinking and reasoning skills.
If you can synthesize complex, abstract problems and collaborate effectively with team members with diverse skillsets to create solutions.
If you bring strong leadership and delegation skills to the table.