Retrieval Operations Lead

This is a fully remote position, open to applicants in United States.

📋 Description

• Act as the main contact for a program's highest-volume AIDs while fostering direct relationships with provider office personnel.

• Oversee retrieval performance for large AIDs and proactively resolve obstacles impacting chase completion.

• Collaborate with provider offices on logistics for record requests, portal access, and ongoing retrieval challenges.

• Allocate and redistribute daily chase assignments among the PSR team based on AID priority, chase age, and retrieval deadlines.

• Supervise PSR workloads and modify assignments to maintain queue efficiency and prevent aged chases from stagnating.

• Work alongside the Retrieval Manager for weekly volume planning and identify any capacity gaps.

• Facilitate the onboarding and training of new PSRs regarding chase workflows, AID ownership, pend code management, and platform agent transitions.

• Provide continuous coaching and refresher training on retrieval best practices, call quality, and documentation standards.

• Keep training materials and job aids current and relevant.

• Handle first-line resolutions for provider escalations related to retrieval outreach, record requests, or access challenges.

• Record escalation trends and root causes, suggesting workflow or script adjustments as necessary.

• Escalate unresolved or systemic provider concerns to the Retrieval Manager, providing a clear summary and proposed next steps.

• Monitor individual and team retrieval rates, pend rates, and productivity against program objectives.

• Offer daily feedback and coaching to PSRs based on chase results and call quality.

• Identify underperformance or training deficiencies and assist in implementing corrective action plans.

• Ensure PSR compliance with standard retrieval processes, procedures, and documentation requirements.

• Maintain precise records regarding AID assignments, escalation status, and chase ownership.

• Assist with updates to processes and revisions of standard operating procedures.

⛳️ Requirements

• Minimum of 2 years of experience in healthcare operations, chart retrieval, risk adjustment, or HEDIS/quality program support.

• At least 1 year of experience in training, coaching, or overseeing the daily activities of other team members.

• Familiarity with risk adjustment and HEDIS retrieval workflows, including concepts related to chase, AID, and pend codes.

• Proven experience managing provider-facing communications, including the direct resolution of access or outreach escalations.

• Strong organizational abilities, with the capacity to manage and rebalance work assignments across a team in a fast-paced setting.

• Proficient in Excel and comfortable using chase or case management systems.

• Exceptional written and verbal communication skills, with a background in delivering training or coaching.

• Direct experience supporting Medicare Advantage or ACA health plan retrieval programs is preferred.

• Previous experience in formally training or onboarding new hires in a call center or retrieval operations environment is preferred.

• Must be eligible to work in the United States.

• E-Verify is required for new hires.

🏝️ Benefits

• Competitive salary.

• Medical, Dental, and Vision benefits.

• 401k match.

• Generous PTO plan.