Job Description

Job Duties and Responsibilities:

Team Leadership & Operations

• Supervise IV and PA agents across multiple LOBs
• Monitor attendance, adherence, productivity, and quality metrics
• Conduct coaching sessions, performance reviews, and corrective actions
• Manage schedules, staffing coverage, and workload distribution
• Support hiring, onboarding, and nesting of new hires

IV & PA Process Oversight

• Oversee verification of insurance coverage, benefits, and eligibility
• Ensure correct identification of authorization requirements across 150+ payers
• Monitor submission, tracking, and completion of authorization requests
• Review complex cases, escalations, and payer issues
• Ensure accurate documentation in EMR and DME systems
• Validate test claims, benefit checks, and payer communications
• Ensure alignment with payer guidelines and billing requirements

DME & RCM Support

• Oversee eligibility and authorization for DME products including:
• Urology and catheter supplies
• Wound care and incontinence products
• Diabetic supplies, nutritional’s, thickeners, and breast pumps
• Ensure correct benefit interpretation and payer compliance
• Support end to end RCM workflows impacting reimbursement

Quality, Reporting & Process Improvement

• Review QA audits and agent outputs for accuracy and consistency
• Track and report team performance on a weekly and monthly basis
• Identify performance gaps and implement corrective action plans
• Maintain SOPs, knowledge base, and job aids
• Drive process improvements and efficiency initiatives

Training & SME Function

• Act as SME for IV and PA processes across programs
• Support or deliver training sessions, refreshers, and upskilling activities
• Assist in onboarding and continuous education of agents
• Provide guidance on payer rules, workflows, and system updates

Cross Functional Collaboration

• Partner with QA, Training, Workforce, Operations, and Client teams
• Support client requirements
• Handle escalations and ensure timely resolution
• Participate in projects, audits, and business initiatives

Performance Metrics

• Productivity and volume targets
• Quality and accuracy scores
• Authorizations turnaround time
• First pass resolution and rework rates
• Attendance and adherence
• SLA compliance

Qualifications

Education & Experience

• Bachelor’s degree or equivalent experience
• 3 to 5 years of experience in US healthcare, RCM, Insurance Verification, or Prior Authorization
• At least 3 years in a supervisory or leadership role
• Experience in medical insurance, benefits investigation, and authorization processes
• Experience supporting DME and multi payer environments preferred
• Background in voice and back-office operations preferred

Skills & Competencies

• Strong knowledge of insurance verification and prior authorization workflows
• Familiarity with EMR, DME systems, payer portals, and database entry
• Strong understanding of HIPAA compliance and medical terminology
• 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

Preferred Qualifications

• Experience supporting US based DME providers similar healthcare clients
• Familiarity with products related to:
  • Urology and catheter supplies
  • Incontinence, wound care, and catheter products
  • Diabetic supplies, nutritional products, thickeners, and breast pumps
• Experience in life sciences, pharmaceutical, or medical device environments
• Experience working in startup or rapid growth operations with evolving processes
• Strong understanding of patient support services, DME workflows, and payer requirements for the above product lines

Language Skills 

Must be able to communicate effectively in English.  Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.  Ability to write routine reports and correspondence.  Ability to speak effectively before groups of customers or employees of the organization.

Compliance and Reporting

• The Operations Supervisor will report to the Operations Manager/Senior Operations Manager or designated offshore operations manager.
• They must adhere to all company policies, including HIP AA compliance, data protection, and ethical conduct.
• Regular performance reviews and audits will be conducted to ensure quality and compliance standards are met.