Insurance Verification Eligibility And Verification Lead Assistant Manager Operations (Remote)

JOB DESCRIPTION: Insurance Verification/Eligibility and Verification – Lead Assistant Manager – Operations

JOB SUMMARY: As a Team Manager for the Eligibility Verification Process within our Revenue Cycle Management department, you will lead a team of eligibility management specialists responsible for analyzing and resolving claim denials to maximize revenue and minimize revenue leakage. This role plays a pivotal part in ensuring efficient and effective denial resolution, improving cash flow, and optimizing the revenue cycle.

REQUIRED EDUCATION/EXPERIENCE: Graduate in any stream; customer service; must be computer literate; have multi-tasking skills, excellent organizational skills, verbal and written communication skills; team player.

YEARS OF EXPERIENCE:

• 8+ years of total experience. 1 to 5 years’ experience as a Team Lead

POSITION RELATIONSHIPS:

• Reports directly to the Assistant Manager

JOB RESPONSIBILITIES:

• Work from Home Position/ Fully Remote (Must meet WFH requirements of quite space and reliable infrastructure)
• Highly Organized
• Superior Moral Compass and Work Ethics
• Operations Management – You excel at aligning client requirements into daily KPI’s that drive operations excellence
• People Coach – Motivate and inspire your team to excel
• Analytical & Problem Solving skills
• Can Communicate with & Present to Clients
• Strong knowledge of healthcare billing and reimbursement processes.
• Proficient in using healthcare information systems and billing software.
• Ability to analyze data and generate reports.
• Demonstrated problem-solving and process improvement skills.

PROFESSIONAL:

• Recognize and respect cultural diversity.
• Adapt communication to an individual’s ability to understand. • Use medical terminology appropriately.
• Respond to communications received within a reasonable time frame.
• Project a professional manner and image.
• Adhere to ethical principles.
• Demonstrate initiative and responsibility.
• Work as a team member.
• Efficient Time Management.
• Prioritize and perform multiple tasks.
• Adapt to change, including new hours of operation and methodology.
• Attend functional team meetings and mandatory in-service education.
• Maintain proper observation and adherence to company policies and procedures.

KNOWLEDGE, SKILLS, AND EXPERIENCE:

• Team Leadership:
• Lead and supervise a team of payment posting specialists.
• Set clear performance expectations and provide regular feedback and coaching.
• Foster a positive and collaborative team environment.
• Manage workload distribution and ensure equitable work allocation.
• Oversee the analysis and resolution of claim, including payer and provider-side discrepancies.
• Develop and implement strategies to reduce denial rates and increase reimbursement.
• Collaborate with other departments to address root causes of denials and prevent recurrence.
• Monitor and manage denial aging, ensuring timely resolution.
• Implement and maintain quality control measures to reduce errors in charge entry.
• Conduct regular audits of charge entries to identify and address discrepancies.
• Provide training and guidance to team members on coding and documentation requirements.
• Generate and analyze reports related to Denials productivity and accuracy.
• Analyze denials to build effective strategies to maximize revenue
• Develop and track key performance indicators (KPIs) for the team.
• Provide regular performance updates to the Revenue Cycle Manager.
• Identify opportunities for process improvement and workflow optimization.
• Collaborate with cross-functional teams to implement process enhancements.
• Stay up-to-date with industry trends and regulatory changes affecting charge entry.
• Ensure that charge entry practices adhere to all relevant healthcare regulations, including HIPAA.
• Stay informed about changes in coding and billing regulations and communicate updates to the team.

LEGAL and COMPLIANCE:

• Maintain patient and company confidentiality.
• Practice within the scope of education, training, and personal capabilities.
• Document company documents (hard copy and electronic) accurately.
• Use appropriate guidelines for releasing information.
• Maintain awareness of US federal and US state health care legislation and regulations, PHI, HIPAA

WORKING HOURS:

• 40 hours per week as Full-time employee
• Shift time: 12 PM IST – 9 PM IST
• Weekends Off

TELECOMMUTER/INTERNET REQUIREMENT:

• High Speed internet connection at home, must be broadband with minimum of 100 MBPS Speed or above
• Must understand and adhere with telecommuter policy
• Must have power backup at to mitigate power outage