Job Description
Job Duties and Responsibilities:
Team Leadership & Operations
- Supervise PA and IV agents, ensuring all tasks meet quality, productivity, and compliance standards.
- Monitor daily workload, attendance, adherence, and performance metrics.
- Conduct coaching, performance reviews, and assist with corrective action as needed.
- Manage team schedules, shift coverage, and workflow distribution.
- Support hiring, onboarding, and training of new agents.
PA & IV Process Oversight
- Oversee verification of medical and pharmacy coverage, insurance benefits, and primary insurance identification.
- Ensure accurate completion of test claims, outbound payer calls, and benefit validation.
- Review escalations and complex payer issues.
- Ensure accurate documentation in company systems and compliance with payer rules.
- Support agents managing high-volume queues (1000+ accounts/month per agent).
DME & RCM Support
- Oversee DME eligibility verification across 150+ payers for diabetic supplies, urological/catheter products, incontinence items, nutritionals, breast pumps, and related healthcare products.
- Ensure correct identification of PA requirements, benefit limitations, and payer guidelines.
Quality, Reporting & Process Improvement
- Review QA results, documentation, and agent output to ensure accuracy and consistency.
- Prepare weekly/monthly team performance reports.
- Communicate updates on process changes, payer guidelines, and system improvements.
- Identify gaps in workflows and recommend improvements.
- Maintain knowledgebase documents, SOPs, and job aids.
Cross-Functional Alignment
- Collaborate with QA, Training, Workforce, Operations, and Client teams.
- Support escalations, respond to inquiries, and ensure smooth process flow.
- Participate in special projects or new initiatives as assigned.
Job Required Qualification:
- Minimum 3-year solid experience with US Healthcare Insurance
- At least 1 year work experience in a customer service call center (Voice and Back office)
- Experience with medical Insurance/Benefits investigation and Authorizations is highly preferred.
- Excellent Customer service skills, including phone and interpersonal skills.
- Computer proficiency in MS Word, Excel, and Outlook preferred
- Typing accuracy of 35 wpm minimum
- Database data entry experience preferred.
- Strong knowledge and use of the English language, both written and verbal
- Work history of excellent attendance and punctuality
- High comfort level working with culturally diverse team members and clients.
- Proficient mathematical skills, including addition, subtraction, multiplication, and division.
Preferred Qualifications:
- Startup / rapid growth experience
- Life sciences, pharmaceutical, or medical device experience.
- Knowledge of medical terminology preferred.
- Knowledge diabetes
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.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions.
