Payer Enablement Specialist

About the role

You will own the end to end payer enablement lifecycle for Tava Health, ensuring that every configuration decision supports scalable and compliant operations. This role requires you to act as the primary liaison between clinical, product, and finance teams to translate payer rules into precise system logic. You will build and maintain the foundational payer infrastructure within our electronic medical record, focusing on accuracy and consistency. The position demands rigorous attention to detail because you will be responsible for validating fee schedules and contractual rates to protect revenue integrity. You will leverage AI enabled tools to streamline documentation and standardize operational workflows across the payer ecosystem. Collaboration will be a core function as you work cross functionally to troubleshoot issues and enable seamless payer updates. Ultimately, this role is about reducing manual effort while improving the quality and scalability of our payer operations.

Key facts

What you'll do

• Build and maintain payer configurations within Tava's EMR to support accurate claims processing and eligibility checks.
• Translate complex payer requirements into standardized system logic and configuration rules that ensure consistency across all payer relationships.
• Manage fee schedules and validate contracted rates to prevent billing errors and support optimal reimbursement outcomes.
• Identify and resolve discrepancies in Tava's EMR and across integrated platforms to maintain data integrity and compliance.
• Maintain and improve Standard Operating Procedures and Insurance Articles to reflect current workflows, payer rules, and operational requirements.
• Partner with Payer Operations, Revenue Cycle Management, Product, and Payer Partnerships teams to align on implementation timelines and requirements.
• Support troubleshooting efforts for payer updates and system related issues by providing clear context and actionable insights.
• Provide clear operational context and documentation to support system improvements and future product development initiatives.
• Audit payer configurations and workflows on a recurring basis to ensure ongoing accuracy, consistency, and adherence to payer guidelines.
• Identify inefficiencies or patterns in errors and escalate appropriately to the relevant operational and technical stakeholders.
• Leverage AI tools and modern technology to automate documentation tasks and improve the efficiency of operational workflows.
• Proactively identify opportunities to reduce manual work through the use of automation, configuration enhancements, and process redesign.
• Collaborate on the design and implementation of configuration standards that promote scalability and long term operational health.
• Contribute to continuous improvement initiatives by monitoring key performance indicators and proposing data driven adjustments to payer processes.

Requirements

You must have a background in operations, consulting, analytics, or a related field, or you must have strong analytical training through university coursework. You need to demonstrate strong analytical and problem solving skills with the ability to break down complex systems into manageable components. High attention to detail is essential, and you must take strong ownership of tasks from completion to refinement. Curiosity and a willingness to learn the healthcare payer and revenue cycle space are required as you will navigate intricate rules and policies. Strong communication skills are necessary to work effectively cross functionally with diverse stakeholders at all levels. You must feel comfortable using modern tools, including artificial intelligence, to improve workflows and increase operational efficiency. You should be excited about using AI and modern tools to rethink how operational work gets done, rather than simply executing existing processes in a traditional manner.

Nice to have

• Digital health experience that provides familiarity with virtual care models and compliance considerations.
• Experience in high growth environments where rapid iteration and adaptability are required.
• Experience with custom systems, rules engines, or configuration heavy platforms that support complex business logic.

Practical notes

This is a full time salaried position with remote work available from anywhere in the United States. Because tax and compliance requirements apply, priority for this role will be given to candidates living in states where Tava Health already has employees, including Alabama, Arizona, California, Colorado, Connecticut, District of Columbia, Florida, Georgia, Idaho, Indiana, Maine, Maryland, Massachusetts, Nevada, New Jersey, New York, North Carolina, Ohio, Oregon, Tennessee, Texas, Utah, and Washington. Tava Health is unable to sponsor employment visas such as the H 1B, and candidates must have authorization to work in the United States without company sponsorship now or in the future. All hiring activities are conducted by company representatives using @tavahealth.com or @us.tavahealth.com email addresses. You are advised to beware of unauthorized recruiting communications requesting personal information, as we never hire anyone without first completing a real time face to face interview, conducted by video or in person, nor do we use encrypted instant messaging services such as Signal. If you have questions regarding the authenticity of any communication, please do not hesitate to use the chat feature on our career page to verify before sharing additional details.