Area Manager-Claims Management-Medical Billing and Claims Processing

Key Responsibilities:

1. Strategic Coordination and Alignment
   1. Serve as the key liaison between POD Leader and Operations/Program Leaders to ensure alignment on client engagement, requirements, and escalation management.
   2. Align POD-level goals with program objectives and the broader business strategy.
   3. Partner with Program and POD Leaders for strategic planning, including forecasting performance, capacity planning, and staffing to meet revenue goals.
2. Audit Life Cycle Management:
   1. Collaborate across functions to ensure effective service delivery throughout the audit lifecycle—from data management and selections to recovery.
   2. Review exceptions, analyze anomalies, and provide insights with appropriate narrative and resolution actions.
   3. Monitor audit KPIs, SLAs including volume, capacity, forecasting, audit completion, TATs, priority completions, and recovery & collection
3. Client Engagement:
   1. Maintain dual accountability with Program Leaders for client-facing communications and engagement.
   2. Respond to adhoc client needs, compliance, and administrative requirements promptly.
   3. Ensure timely and appropriate client communication alongside Program Leaders.
4. Analytics and Technology:
   1. Lead analytics initiatives in collaboration with Program Leaders for business intelligence and advanced reporting solutions.
   2. Drive technology initiatives to enhance operational efficiencies and work closely with Program Leaders on solutioning.
5. Service Delivery Excellence & Operational Efficiency
   1. Conduct continuous 360-degree reviews of service delivery and identify improvement areas.
   2. Work with Program Leaders to uphold high standards and timely delivery of all reports to senior leadership.
   3. Identify revenue leakage and bottlenecks; collaborate cross-functionally to implement scalable solutions.
   4. Facilitate regular review meetings with Program and POD Leaders to discuss progress and insights.
   5. Present performance metrics, revenue trends, and risk assessments to senior management.
6. Digital Transformation
   1. Collaborate with Digital Engineering and Tech teams to evaluate and implement automation and analytics tools aligned with business objectives.