Area Manager-Claims Management-Medical Billing and Claims Processing

Job details

Job Description: Key Responsibilities:

Strategic Coordination and Alignment
- Serve as the key liaison between POD Leader and Operations/Program Leaders to ensure alignment on client engagement, requirements, and escalation management.
- Align POD-level goals with program objectives and the broader business strategy.
- Partner with Program and POD Leaders for strategic planning, including forecasting performance, capacity planning, and staffing to meet revenue goals.

Audit Life Cycle Management:
- Collaborate across functions to ensure effective service delivery throughout the audit lifecycle—from data management and selections to recovery.
- Review exceptions, analyze anomalies, and provide insights with appropriate narrative and resolution actions.
- Monitor audit KPIs, SLAs including volume, capacity, forecasting, audit completion, TATs, priority completions, and recovery & collection

Client Engagement:
- Maintain dual accountability with Program Leaders for client-facing communications and engagement.
- Respond to adhoc client needs, compliance, and administrative requirements promptly.
- Ensure timely and appropriate client communication alongside Program Leaders.

Analytics and Technology:
- Lead analytics initiatives in collaboration with Program Leaders for business intelligence and advanced reporting solutions.
- Drive technology initiatives to enhance operational efficiencies and work closely with Program Leaders on solutioning.

Service Delivery Excellence & Operational Efficiency
- Conduct continuous 360-degree reviews of service delivery and identify improvement areas.
- Work with Program Leaders to uphold high standards and timely delivery of all reports to senior leadership.
- Identify revenue leakage and bottlenecks; collaborate cross-functionally to implement scalable solutions.
- Facilitate regular review meetings with Program and POD Leaders to discuss progress and insights.
- Present performance metrics, revenue trends, and risk assessments to senior management.

Digital Transformation
- Collaborate with Digital Engineering and Tech teams to evaluate and implement automation and analytics tools aligned with business objectives.

Responsibilities: Manager - POD Operations: Key Responsibilities

Working Hours: 40 HOURS PER WEEK, FULL TIME EMPLOYEE.

Key Competencies:

Strategic Coordination: Facilitate seamless alignment and collaboration between POD and Program operations to support overall business goals.

Audit Lifecycle Oversight: Manage the end-to-end audit process, ensuring timely, accurate, and compliant execution of audits.

Service Delivery Excellence: Drive continuous improvements in service quality to enhance client satisfaction and operational performance.

Client Relationship Management: Build and maintain strong client relationships, addressing their needs and resolving issues promptly.

Support Growth Initiatives: Partner with business development teams to identify and enable growth opportunities within POD operations.

Analytics and Technology Enablement: Lead adoption of data analytics and technology tools to improve decision-making and operational efficiency.

Compliance Management: Ensure all processes comply with regulatory requirements and internal policies, addressing any gaps proactively.

Stakeholder Engagement: Act as a bridge between key stakeholders, facilitating clear communication and collaboration.

Revenue Optimization: Identify and implement strategies to maximize revenue and profitability within POD operations.

Operational Efficiency: Continuously optimize workflows and processes to reduce costs, increase productivity, and meet performance targets.

Qualifications: Bachelor’s degree in any or related field; MBA or relevant advanced degree preferred.

Experience: Minimum of 10 years’ experience in US Healthcare and Payment Services LOB preferred.

5+ years of experience in operations management, preferably in audit lifecycle or service delivery domains.

Proven experience in strategic planning, client engagement, and cross-functional team leadership.

Strong analytical skills with proficiency in metrics tracking, reporting, and business intelligence tools.

Familiarity with digital transformation initiatives and technology-driven process improvements.