Usrn - Lead/Sme (Hybrid, Mcg & Interqual Exp Required)

Overview

Under general supervision, the Lead is responsible for supervising the assigned team and ensure that the team adheres to SLAs specified by the client or process for productivity, achieving expected quality and revenue goals and schedule adherence. The Lead is considered a mentor, trainer, developer of less tenured team members. Responsible for developing new and existing audit concepts. Maintain KPI for assigned sites and assist team with meeting deadlines, as needed. Work with other leads and managers (Client) to resolve issues or escalations resulting from any errors. Hold team accountable for meeting deadlines, completing monthly reconciliation, completing missing information, and effectively report delays and issues in a timely manner. Review and analysis of periodic reports and metrics. Will be accountable for daily/weekly performance updates to key stakeholders in weekly meetings. Responsible for managing attrition and building retention strategies. Providing regular performance feedback, giving frequent formal and informal coaching sessions and best practice sharing for accurate processing. Responsible for queue management, shift staffing and roster management as applicable. Provide support to quality initiatives targeted towards process improvements. Assist in hiring new team members. Perform other duties as assigned. Willing to go the extra mile when needed. Should be comfortable handling remote staff and office-based staff.

• Supervise the assigned team and ensure adherence to SLAs specified by the client or process for productivity, quality, revenue goals, and schedule adherence.
• Serve as a mentor, trainer, and developer of less tenured team members; develop new and existing audit concepts.
• Maintain KPI for assigned sites and assist the team with meeting deadlines as needed.
• Collaborate with other leads and client managers to resolve issues or escalations resulting from errors.
• Hold the team accountable for meeting deadlines, completing monthly reconciliation, providing missing information, and reporting delays and issues promptly.
• Review and analyze periodic reports and metrics; provide daily/weekly performance updates to key stakeholders in weekly meetings.
• Manage attrition and implement retention strategies.
• Provide regular performance feedback, coaching, and best-practice sharing for accurate processing.
• Manage queue, shift staffing, and roster management as applicable.
• Support quality initiatives aimed at process improvements.
• Assist in hiring new team members.
• Perform other duties as assigned.
• Be willing to go the extra mile when needed; comfortable handling remote and office-based staff.

• Must have active USRN mainland license. AHIMA or AAPC medical coding certification not required but an advantage.
• Lean Training and Certification an advantage.

• Should have overall 5+ year work experience with a minimum of 2 years in the role of Supervisor in a BPO setting with knowledge on one or all fields or medical Utilization Management and Review.
• Profound understanding and application of Milliman and InterQual guidelines.
• Ability to effectively handle large teams in a fast-moving business environment.
• Comfortable creating process workflows and documenting processes.
• Understanding and well versed in the application and process of Utilization Management, and/or Appeals and Grievance.

• Proficient knowledge on US Healthcare Practice, Clinical Documentation Improvement, medical terminologies, EDI, and HIPAA protocols are a must.
• Excellent collaboration skills and good work ethics.
• Excellent verbal and written business communication skills required.
• Strong proficiency in Windows OS and Microsoft Office applications.
• Self-starter who can manage multiple priorities with minimum direction.
• Knowledge on different platforms used in the conduction of UM reviews.