Insurance Verification Lead

Posted:
12/11/2024, 3:43:47 AM

Location(s):
Washington, United States

Experience Level(s):
Senior

Field(s):
Product

Workplace Type:
Remote

Mission

Empower everyone to live a long, full and optimal life by redefining the future of heart health.

1 in 3 humans die of heart disease - it's time to change that.

We're designing heart health from the ground up so that humans can live fuller lives. We're building technology to accelerate recovery after a cardiac event. And we're optimizing health stacks to realize preventive and aspirational goals.

Recora is redefining the future of heart health — we invite you to join us on this mission.

About Recora

Recora was founded in 2020 by seasoned digital health entrepreneurs. In past roles, we've founded and scaled high-growth startups, run large health systems, advised government programs, built technology you use every day, and provided healthcare for millions of lives.

We're backed by leading VCs including SignalFire, Pear, GFC , 2048, Great Oaks, MGV and more. Over the last year, we've built the leading virtual cardiac recovery and management platform for members with cardiac conditions. For every member we serve, we add an average of five years to their lifespan.

We're growing – fast. Our member base is doubling every month and we're looking to 3x our team size quickly. This will allow us to scale nationally and accelerate product development across the continuum of heart health.

Who We Are

We are innovators at heart. This driving force guides us to create, build, partner, and operate at the highest levels. We seek answers to some of the hardest problems in technology and healthcare and enjoy the process of finding unexplored solutions.

We're a group of diverse, thoughtful and humble folks. Having worked in organizations of every size and shape, we know that people make or break teams. An open, ego-free and supportive culture is central to making the best team of people at Recora.

As a team, we love our work and love working together. We take ownership in Recora and strive to grow personally and professionally in service of our mission. Because we enjoy hard problems and value growth, we can celebrate both challenges and excellence in equal measure.

Job Title: Insurance Verification Lead 

Classification: 1099 

Work Structure: Fully Remote

Hours/Shift: Monday-Friday, Day Shift (EST), 40 hours/week

Team: Enrollment Operations

Reports to: Sr. Program Manager

Location: United States (EST or CST Preferred)

Compensation: $25 per hour

 

About Us

We are a mission-driven organization of clinicians, engineers, and professionals dedicated to transforming cardiovascular health. Our focus is on reducing the impact of heart disease through innovative solutions. Leveraging evidence-based research and telemedicine, we deliver specialized exercise and wellness programs tailored to older adults. Our goal is to enhance patients’ lives by promoting heart health and offering exceptional care that makes a lasting impact.



Job Summary

As an Insurance Verification Lead, you will lead a team responsible for verifying patient insurance benefits and ensuring the necessary authorizations for treatments are obtained. This role involves analyzing insurance coverage, communicating with insurance providers, and collaborating across departments to streamline billing and authorization processes. You will play a key role in patient coordination and contribute to the company’s mission of improving heart health outcomes.

 

Key Responsibilities

Insurance Verification and Authorization

  • Review and validate patient insurance information, ensuring accuracy in billing and demographic details.
  • Determine member benefit coverage for treatments and procedures.
  • Obtain and confirm prior authorizations from insurance companies and document patient accounts accordingly.

Team Leadership and Development

  • Lead a team of insurance verification specialists, providing coaching and performance feedback to ensure high standards of insurance verification quality and accuracy.
  • Manage training for team roles, maintaining alignment with operational goals and KPIs.

Patient Coordination and Communication

  • Communicate with patients regarding co-pays, coverage, benefits, and care authorizations.
  • Support cross-functional collaboration by sharing insurance authorization and appeals processes with providers and assisting the scheduling team.

Continuous Improvement and Performance Analysis

  • Analyze and optimize outreach methods to improve patient engagement, collaborating with Product & Engineering teams to refine technical workflows.
  • Develop best practices and evaluate key performance indicators (KPIs) for the insurance verification process.

Documentation and Compliance

  • Maintain accurate records in compliance with HIPAA and ensure patient data confidentiality.
  • Produce clear documentation to align teams and communicate complex workflows effectively.

 

Qualifications

Experience:

  • 3-5 years of experience in member acquisition/retention for Medicare Advantage and commercial plans.
  • 3-5 years of experience in benefits verification operations, including 2+ years in team management.
  • Experience screening, hiring, and managing teams of 10+, with a track record of meeting KPIs.

Knowledge and Skills:

  • Strong knowledge of healthcare topics, including insurance products, ICD-10 billing, CPT codes, and EHR systems.
  • Proficiency with CRM, ticketing queues, spreadsheets, and outreach tools.
  • Excellent electronic communication skills, both verbal and written, with a demonstrated ability to handle time-sensitive situations. Experience with Slack is a plus. 

Personal Attributes:

  • Proactive, results-driven, and adept at handling fast-paced, startup environments.
  • Strong work ethic, sound judgment, and a commitment to continuous improvement.
  • Analytical mindset and problem-solving skills with experience in developing data-driven solutions.

 

Additional Information

This role requires adherence to HIPAA and company confidentiality guidelines. All employees must pass a background check.

This description provides an overview of the Insurance Verification Manager’s responsibilities and qualifications. As the company grows, job requirements may evolve to meet changing needs.



*Note: This is a 1099 contractor position