Job Description

Job Brief:

The Hybrid Operations Supervisor is responsible for overseeing day-to-day operations of the Access & Reimbursement team while serving as a Subject Matter Expert (SME), Client Liaison, Trainer, and Quality Auditor. This role provides operational leadership and guidance to specialists managing Benefits Investigations (BI), Prior Authorizations (PA), Gap Exceptions, Referrals, and reimbursement-related activities. The supervisor serves as the primary escalation point for complex cases, supports client relationships, drives process excellence, and ensures quality, productivity, and service level expectations are achieved. The role supports the functions performed by the Access and Reimbursement Specialist team, including insurance verification, prior authorization management, reimbursement support, and Territory Manager coordination.

The ideal candidate is highly adaptable and capable of supporting multiple healthcare support workflows. This individual is expected to flex across programs, processes, and client needs while maintaining operational excellence and team engagement.

Success in this role comes from strong leadership, deep knowledge of healthcare processes, and the ability to coach and develop agents while maintaining high standards in quality, productivity, and compliance.

Job Duties and Responsibilities:

Operations Leadership & Team Supervision

• Provide daily leadership and oversight for Access & Reimbursement Specialists.
• Monitor productivity, quality, service levels, and turnaround times.
• Manage staffing plans, workload distribution, and queue prioritization.
• Conduct regular coaching, feedback sessions, and performance reviews.
• Drive employee engagement and support professional development initiatives.
• Serve as the first point of escalation for operational and case-related issues.

Subject Matter Expert (SME)

• Act as the team's primary resource for complex Benefits Investigation, Prior Authorization, Gap Exception, Referral, and reimbursement-related inquiries.
• Provide guidance on payer requirements, insurance coverage determinations, and reimbursement best practices.
• Support resolution of escalated provider, payer, patient, and Territory Manager concerns.
• Stay current on payer policy updates, reimbursement changes, and client-specific processes.
• Assist with workflow development, process improvements, and standard operating procedures.

Client Communication & Relationship Management

• Serve as a primary operational contact for clients and stakeholders.
• Participate in client meetings, business reviews, and operational discussions.
• Provide performance updates, operational insights, and action plans.
• Manage follow-up on client requests, concerns, and process enhancements.
• Foster strong partnerships with Territory Managers, provider offices, and client leadership teams.

Training & Development

• Lead onboarding and new hire training programs.
• Conduct refresher training and ongoing skills-development sessions.
• Identify knowledge gaps and implement targeted coaching plans.
• Maintain training materials, job aids, and process documentation.
• Support cross-training initiatives to ensure team flexibility and business continuity.

Quality Assurance & Compliance

• Perform quality audits on Benefits Investigations, Prior Authorizations, Gap Exceptions, referrals, documentation, and client communications.
• Evaluate adherence to process requirements, quality standards, and regulatory guidelines.
• Deliver coaching and corrective action based on audit findings.
• Track quality trends and recommend improvement initiatives.
• Ensure compliance with HIPAA, client requirements, and internal policies.

Process Improvement & Reporting

• Analyze operational metrics and identify opportunities for efficiency improvements.
• Monitor productivity, quality, client satisfaction, and turnaround time trends.
• Develop action plans to address performance gaps.
• Support implementation of new workflows, technologies, and client initiatives.
• Provide regular reports and insights to leadership and clients.

Flexibility & Cross-Functional Support

• Demonstrate the ability to support multiple workstreams, programs, and healthcare operational processes.
• Assist with special projects, pilot programs, and new client implementations.
• Adapt quickly to changing business priorities and client requirements.
• Provide hands-on support during periods of increased volume, staffing gaps, or operational transitions.
• Maintain proficiency across various healthcare support functions to ensure operational continuity.

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 (Preffered)
• 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
• Strong understanding of commercial, Medicare, Medicaid, HMO, and PPO insurance plans.
• Experience with Benefits Investigations, Prior Authorizations, Referrals, Appeals, and reimbursement workflows.
• Excellent communication, presentation, coaching, and stakeholder management skills.
• Strong analytical and problem-solving abilities.
• Ability to manage multiple priorities in a fast-paced environment.

Preferred

• Experience supporting specialty pharmacy, medical device, DME, endocrinology, or patient support programs.
• Experience working directly with Territory Managers, Field Reimbursement Managers, or Sales teams.
• Experience conducting quality audits and developing training programs.
• Knowledge of CRM platforms, payer portals, and reimbursement management systems.

Key Performance Indicators (KPIs)

• Team productivity and SLA attainment
• Quality audit scores
• Training effectiveness and onboarding success
• Prior Authorization turnaround time
• Benefits Investigation accuracy rate
• Escalation resolution time
• Client satisfaction scores
• Territory Manager satisfaction
• Employee engagement and retention
• Process improvement and operational excellence initiatives

  Ideal Candidate Profile

The ideal candidate is a versatile healthcare operations leader with strong reimbursement expertise, exceptional communication skills, and a passion for developing people. They can seamlessly transition between acting as an SME, trainer, quality auditor, client-facing representative, and operational supervisor. They thrive in dynamic environments, can support multiple processes as business needs evolve, and consistently deliver high-quality service to clients, providers, and internal stakeholders.

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 HIPAA compliance, data protection, and ethical conduct.
• Regular performance reviews and audits will be conducted to ensure quality and compliance standards are met.