Job Description

Job Duties and Responsibilities:

Team Leadership, Operations, and Evolving Supervisory Scope

• Perform IV and PA production work, support, and responsibilities based on client needs
• Support onboarding and nesting of new hires as requested by the client
• Provide process guidance using IV and PA expertise
• Assist with knowledge sharing and workflow clarification
• Escalate risks, issues, and performance gaps to client leadership
• Help maintain consistency in documentation and adherence to client processes
• Monitor attendance, adherence, productivity, and quality metrics for visibility and reporting to the client
• Support schedule coordination, staffing coverage, and workload distribution based on client direction

IV and PA Process Execution and Oversight

• Perform and support insurance verification, benefits investigation, and eligibility checks
• Identify authorization requirements across multiple payers based on client guidelines
• Submit, track, and follow up on prior authorization requests
• Review complex cases, escalations, and payer-related issues, then elevate to the client as needed
• Ensure accurate documentation in client systems including EMR and DME platforms
• Validate benefit checks, test claims, and payer communications
• Ensure alignment with payer guidelines and billing requirements as defined by the client

DME and RCM Support

• Support eligibility and authorization workflows for client-specific products and services as directed
• Ensure accurate interpretation of benefits and alignment with payer requirements
• 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 IV and PA processes
• Support or assist in training sessions, onboarding, and upskilling initiatives as directed by the client
• 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
• 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

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.