Job Description

Job Duties and Responsibilities:

Team Leadership and Operations

• Supervise your Team ensuring all tasks meet quality, productivity, and compliance standards.
• Supervise multiple LOBs and mixed agents between PH and MX with ease.
• Monitor workload, attendance, adherence, and performance metrics.
• Conduct coaching, performance reviews, and assistance with corrective action as needed.
• Manage and support schedule coordination, staffing coverage, and workload distribution based on client direction
• Provide process guidance using Member & Provider/Prescribers outreach, Document Retrieval, and AR Billing expertise
• Assist with knowledge sharing and workflow clarification, implementation, and improvement.
• Escalate risks, issues, and performance gaps to client leadership
• Help maintain consistency in documentation and adherence to client processes

Document Retrieval Process Execution and Oversight

• Perform and support Document Retrieval/Document Collection task as needed.
• Ensure accurate Medical Records such as prescriptions, purchase order (PO), Doctor’s order (DO), chart notes, CMNs (Clinical Medical Necessity), and any supporting documentation in compliance with CMS and Insurance/payer’s requirements are secured.
• Validate, review and document the valid Medical Records and ensure accurate documentation in client systems including EMR/CRM and DME platforms.
• Ensure alignment with payer guidelines and billing requirements as defined by the client.
• Review complex cases, escalations, and payer-related issues, then elevate them to the client as needed.
• Maintain
• Build rapport and maintain positive relationships with physicians, referral partners, and patients.
• Update and maintain accurate patient billing records on the system.
• Work assigned pipelines strategically, prioritizing high-impact opportunities to maximize output.
• Navigate IVRs, gatekeepers, and clinic workflows professionally and persistently.
• Demonstrate strong organizational and time-management skills, with the ability to prioritize and plan
• Handle multiple responsibilities simultaneously without compromising quality or efficiency
• Exhibit a proactive mindset, anticipating needs and resolving issues before they arise
• Navigate IVRs, gatekeepers, and clinic workflows professionally and persistently.
• Provide input to help elevate process improvements that will benefit patients, clinicians, colleagues, and overall operations.

AR-Account Receivables Billing Process Execution and Oversight

• Perform and support AR Billing task as needed.
• Perform and support in Identifying and resolving billing errors, underpayments, or overpayments.
• Printing Accounts Receivables (AR) and working on it (as needed)
• Accurately execute claim processing tasks by following detailed project instructions.
• Update and maintain accurate patient billing records.
• Review Explanation of Benefits (EOBs) and electronic remittance advice (ERA) for accuracy, post payments, and address denials.
• Prepare and submit accurate professional claims to insurance companies, government payers, or third-party payers.
• Verifying the payor IDs and claims addresses are correct in accordance with each payor’s specifications.
• Communicate with payers to verify claim status, resolve disputes, and obtain necessary documentation.
• Moving deductibles, coinsurances, and non-covered items from insurance to patient responsibility
• Communicate with patients to obtain missing information, patient responsibility, etc. (ex. Insurance Info).
• Setting up electronic communications and maintaining insurance changes in company software.

DME and RCM Support

• Support necessary workflows for client-specific products and services as directed.
• Implement strategic approaches to support client-specific Lines of Businesses.
• Support end-to-end RCM workflows that impact reimbursement outcomes

Quality, Reporting, and Process Improvement

• Review QA feedback and outputs for accuracy and consistency
• Track and report performance insights to the client on a regular basis
• Identify gaps and recommend corrective actions for client review
• Maintain SOPs, knowledge base, and job aids aligned with client processes
• Support process improvement initiatives and efficiency efforts

Training and SME Support

• Act as SME for the assigned processes or Lines of Business.
• Support or assist in training sessions, onboarding, and upskilling initiatives as directed by the client or as needed.
• Provide guidance on payer rules, workflows, and system updates
• Supports client-led performance management, training, and process improvements

Cross Functional Collaboration

• Partner with QA, Training, Workforce, Operations, and client teams
• Support client requirements and program needs
• Handle escalations and ensure timely coordination with the client
• Participate in projects, audits, and business initiatives as required

Qualifications

Education & Experience

• Bachelor’s degree or equivalent experience
• Minimum of 3 years in a supervisory or leadership role (handled Voice and Non-Voice)
• 3 to 5 years of experience in US healthcare for both Voice and Back Office Lines of Businesses.
• 3 to 5 years of experience in RCM, specific to Member and Provider/Prescribers Outreach, Medical Records Review, Document Retrieval, and AR Billing preferred.
• Experience in Customer Service or Inbound calls preferred.
• Experience supporting DME and multi payer environments preferred.
• Exposure and experienced in DME Products like Diabetic Supplies, Enteral Nutrition Supplies / Medical Foods, incontinence supply, urology supply, ostomy supply, Prosthetic Devices, and Breastfeeding Supplies.
• Background in voice and back-office operations preferred.

Skills & Competencies

• Strong knowledge in RCM specific to Member and Provider/Prescribers Outreach, Medical Records Review, Document Retrieval, and AR Billing workflows

• Familiarity with EMR/CRM, DME systems, payer portals, and database entry
• Strong understanding of HIPAA compliance and medical terminology
• Strong understanding in different types of Medical Records, retrieving documents from provider or prescribers, and accounts receivables Billing.
• Strong understanding of member and provider/prescriber outreach processes, including various payer and insurance calling protocols.
• Strong understanding of Account Receivable and Billing protocols and process.
• Proficiency in MS Word, Excel, and Outlook
• Typing speed of at least 35 WPM with high accuracy
• Strong analytical and reporting skills
• Strong communication, customer service, and coaching skills
• Strong English proficiency, both written and verbal
• Ability to manage high volume workloads and meet performance targets
• High attention to detail and documentation accuracy
• Strong attendance, reliability, and accountability
• Ability to work effectively with diverse teams and clients
• Basic mathematical skills