USRN - Lead/SME (Hybrid, MCG & Interqual Exp Required)

4 days ago

Taguig, National Capital Region, Philippines UST Full time ₱900,000 - ₱1,200,000 per year

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

Qualifications:

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

Work Experience:

  • 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
  • Should have the ability to effectively handle large teams in a fast-moving business environment
  • Must be comfortable creating process workflows and documenting processes
  • Understanding and well versed in the application and process of Utilization Management, and/ or Appeals and Grievance

Other requirements:

  • 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

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