Note: The job is a remote job and is open to candidates in USA. Alaffia Health is a healthtech company that helps health plans reduce improper payments and administrative waste through claims operations, clinical expertise, and AI. The Provider Relations Operations Associate will manage the end-to-end payment integrity audit lifecycle, coordinate documentation requests and provider communications, prepare audit findings, optimize workflows, and maintain accurate records while delivering a professional provider experience.
Responsibilities
- **Own the audit lifecycle:** Track and manage cases from initial document request to final audit finding, ensuring deadlines are met and communication is timely
- **Send and follow up on documentation requests:** Coordinate with providers to obtain required medical records, maintaining professionalism and persistence in all outreach. Additionally, accessing customer electronic systems to obtain records when needed
- **Manage the provider inbox:** Monitor incoming provider communications, triage requests, and respond to inquiries within established turnaround times
- **Compose and send audit finding letters:** Prepare and deliver audit determinations and outcome communications, ensuring clarity and accuracy in all correspondence
- **Optimize workflows:** Identify process gaps and inefficiencies; update SOPs to drive greater consistency, accuracy, and throughput
- **Maintain organized documentation:** Log all communications, updates, and task completions within internal systems to ensure full audit traceability
- **Collaborate cross-functionally:** Work closely with clinical auditors, appeal teams, and product teams to resolve issues and ensure smooth handoffs
- **Deliver a high-touch provider experience:** Represent Alaffia Health professionally in all interactions — balancing compliance with empathy and customer care
Skills
- * This position requires current authorization to work in the United States. Unfortunately, we are not in a position to sponsor work visas at this time
- * 4+ years of experience in healthcare operations, provider relations, or audit support (payment integrity, utilization review, claims, or revenue cycle experience preferred)
- * Excellent written and verbal communication skills — able to write clear, professional correspondence to providers and clients
- * Highly organized and comfortable managing multiple concurrent workflows in a fast-paced environment
- * Strong sense of accountability and ownership; you take initiative and don't let details slip
- * Exceptionally detail-oriented with a keen eye for accuracy and completeness in documentation, communication, and data entry
- * Familiarity with claims auditing, medical record procurement, or health plan operations is a plus
- * Proficient in Microsoft Office Suite (Excel, Word, Outlook) and Google Workspace (Docs, Sheets); comfortable using formulas, filters, and pivot tables for tracking and reporting
- Payment integrity, utilization review, claims, or revenue cycle experience preferred
- Familiarity with claims auditing, medical record procurement, or health plan operations is a plus
Benefits
- Equity
- Medical, Dental and Vision benefits
- Flexible, paid vacation policy
- Remote work
Company Overview