Team Manager- RCM
6 days ago
Role & responsibilities
Key Responsibilities:
- Lead and manage a team of specialists handling Eligibility & Benefits Verification and Prior Authorization.
- Oversee day-to-day operations, ensuring SLAs, quality standards, and productivity targets are met.
- Review and analyze authorization and eligibility data to identify trends, gaps, and opportunities for process improvement.
- Ensure timely verification of insurance coverage, benefit details, and preauthorization requirements.
- Liaise with insurance payers and provider offices to resolve complex authorization or eligibility issues.
- Implement and maintain standard operating procedures (SOPs) in compliance with payer requirements and HIPAA regulations.
- Provide coaching, training, and performance feedback to team members regularly.
- Collaborate with internal teams including patient access, billing, and coding to ensure clean claim submissions.
- Monitor and report on key performance indicators (KPIs) and provide regular updates to senior leadership.
- Handle escalations related to payer communications, patient inquiries, or team performance.
- Stay current with industry regulations, payer policy changes, and best practices.
Preferred candidate profile
- Bachelors degree in Healthcare Administration, Business, or a related field (preferred).
- Minimum of 5+ years experience in Revenue Cycle Management with at least 2 years in a leadership or supervisory role.
- Strong knowledge of U.S. healthcare insurance, including Medicare, Medicaid, and commercial payers.
- In-depth experience in Eligibility & Benefits Verification (EVBV) and Prior Authorization workflows.
- Proficient in EHR/RCM systems (e.g., Epic, Cerner, eClinicalWorks, Athenahealth, etc.).
- Excellent communication, leadership, and problem-solving skills.
- Ability to analyze data and generate actionable insights.
- Strong understanding of HIPAA and other healthcare compliance standards
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