Tampa/Clearwater, Florida

Company Overview

We are a growing medical software company based in Tampa/Clearwater, Florida, pushing to become the ecommerce platform of the medical industry. Our innovative solutions streamline healthcare operations while enhancing patient care and provider efficiency. We are seeking a detail-oriented and experienced Medical Insurance Verification Manager to join our team and lead our insurance verification operations.

Position Summary

The Medical Insurance Verification Manager will be responsible for overseeing and optimizing our insurance verification department, ensuring accurate verification of patient insurance coverage, and maintaining efficient workflows. This role will lead a team of insurance verification specialists, implement best practices, and collaborate with other departments to ensure seamless operations. The position requires strong leadership skills, in-depth knowledge of medical insurance verification processes, and a commitment to operational excellence.

Key Responsibilities

Team Leadership & Development

Recruit, train, and manage a team of insurance verification specialists, including remote overseas staff
Establish performance metrics and conduct regular evaluations to ensure team effectiveness
Provide coaching, mentoring, and professional development opportunities for team members
Create and maintain comprehensive training materials and standard operating procedures
Foster a positive work environment that promotes accuracy, efficiency, and continuous improvement

Operational Management

Develop and implement efficient workflows for insurance verification processes
Monitor daily operations and make adjustments as needed to optimize productivity
Establish quality control measures to ensure accuracy in verification processes
Track and analyze key performance indicators (KPIs) to identify areas for improvement
Implement technology solutions to automate and streamline verification processes
Manage workload distribution among team members to ensure timely completion of tasks

Insurance Verification Oversight

Ensure accurate verification of patient insurance eligibility, benefits, and coverage
Oversee the pre-authorization and referral processes for medical services
Implement best practices for insurance verification in accordance with industry standards
Stay current with changes in insurance policies, procedures, and regulations
Develop strategies to reduce claim denials and improve clean claim rates
Establish protocols for handling complex insurance verification cases

Compliance & Regulatory Management

Ensure compliance with HIPAA, HITECH, and other relevant healthcare regulations
Stay informed about changes in healthcare laws and insurance requirements
Implement and maintain policies and procedures that adhere to regulatory standards
Conduct regular audits to ensure compliance with established protocols
Collaborate with the compliance team to address any regulatory concerns

Cross-Departmental Collaboration

Work closely with billing, coding, and revenue cycle management teams
Collaborate with IT department to implement and optimize verification software
Coordinate with clinical departments to ensure proper documentation for insurance purposes
Participate in leadership meetings to align verification processes with organizational goals
Serve as a liaison between insurance companies and internal departments

Reporting & Analysis

Generate regular reports on verification metrics, productivity, and outcomes
Analyze trends in insurance verification to identify opportunities for improvement
Prepare and present performance data to senior management
Develop strategies to address challenges identified through data analysis
Track and report on denial rates, verification accuracy, and other key metrics

Ecommerce Platform Integration

Collaborate with the technology team to integrate insurance verification processes into our ecommerce platform
Develop strategies for streamlining insurance verification in an ecommerce environment
Identify opportunities to leverage technology for improved verification efficiency
Contribute to the development of user-friendly interfaces for insurance verification

Qualifications

Education & Experience

Bachelor's degree in Healthcare Administration, Business Administration, or related field (required)
3+ years of experience in medical insurance verification or related healthcare field
2+ years of supervisory or management experience in a healthcare setting
Experience with medical billing software and electronic health record (EHR) systems
Knowledge of medical terminology, CPT, and ICD-10 coding
Certification in healthcare administration or revenue cycle management (preferred)

Technical Skills

Proficiency in insurance verification software and practice management systems
Strong computer skills, including Microsoft Office Suite (Excel, Word, PowerPoint)
Experience with data analysis and reporting tools
Familiarity with healthcare ecommerce platforms (preferred)
Understanding of electronic claims submission processes
Ability to learn and adapt to new software systems quickly
Experience managing remote teams and virtual collaboration tools

Healthcare Industry Knowledge

In-depth understanding of health insurance plans, including Medicare, Medicaid, and commercial insurance
Knowledge of medical billing and coding practices
Familiarity with healthcare revenue cycle management
Understanding of healthcare compliance regulations (HIPAA, HITECH)
Awareness of current trends in healthcare insurance and reimbursement
Knowledge of medical ecommerce platforms and digital health solutions
Understanding of the unique challenges in the medical software industry

Leadership & Interpersonal Skills

Proven ability to lead and motivate a team, including remote overseas staff
Excellent communication skills, both written and verbal
Strong problem-solving and decision-making abilities
Ability to manage multiple priorities in a fast-paced environment
Detail-oriented with a commitment to accuracy and quality
Cultural sensitivity and awareness when managing diverse teams
Ability to implement change management strategies effectively
Strong negotiation and conflict resolution skills

Working Conditions

Full-time position based in our Tampa/Clearwater, Florida office
Monday to Friday, standard business hours
Occasional overtime may be required during peak periods
Option for hybrid remote/in-office work schedule within the Tampa/Clearwater area
May require occasional early morning or evening hours to coordinate with overseas team members

Compensation & Benefits

Competitive salary range: $40,000 - $60,000 annually, commensurate with experience and qualifications
Comprehensive health insurance package
Professional development opportunities
Career advancement potential

Reporting Relationship

Reports to: Director of Revenue Cycle Management
Direct Reports: Insurance Verification Specialists (both local and remote overseas team members)

Application Process

Qualified candidates should submit a resume and cover letter detailing their relevant experience and qualifications. Please include "Medical Insurance Verification Manager - Tampa/Clearwater" in the subject line.

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.