Benefits Investigation Supervisor

Koya is always looking for curious and passionate individuals who want to join a fast-paced team for a career in transforming venous and lymphatic care through innovative people-centric technologies that improve lives and empower self-care. Koya values integrity, humility, hard-work, camaraderie, and fun. We offer a base + bonus compensation package, and a competitive benefits program. About the Role: Koya Medical has an immediate need for a full-time Benefits Investigation Supervisor interested in joining an organization at the ground floor (early commercialization phase). The Supervisor will lead and develop the Benefits Investigation team, serving as the escalation point for complex insurance cases while ensuring the team accurately and efficiently verifies patient benefits to support onboarding of new patients/customers. The goal of the position is to drive team performance, quality, and throughput across the Benefits Investigation process while maintaining a high standard of accuracy and compliance. The candidate must be a strong people leader, agile learner, and self-motivated, with the ability to coach and develop a team in a fast-paced, high-growth environment. They must deliver the daily essential job responsibilities, and have the drive, and talent to grow the role and with the company as it scales. The job requires strong leadership, administrative, organizational, and) communication (oral and written skills, along with specialized knowledge of insurance benefits, coverage, and policy. The candidate must also be confident and resourceful when faced with challenges experienced at a start-up company. Position Responsibilities: Supervises the day-to-day activities of the Benefits Investigation team, including workload distribution, staffing, scheduling, and coverage. Hires, trains, coaches, and evaluates Benefits Investigation Representatives; conducts regular performance reviews and manages individual performance improvement as needed. Monitors team productivity, turnaround times, and accuracy against established KPIs; develops and implements process improvements to meet business goals. Serves as the escalation point for complex insurance and eligibility verification cases, and for escalations from Field Sales and Internal parties regarding Patient Benefits. Reviews and quality-checks patient insurance eligibility verifications and benefit quotes for Commercial and Medicare FFS insurances to ensure accuracy and timeliness. Maintains and disseminates a working knowledge of third-party payer guidelines to the team, and partners with the Payer Operations team on insurance authorizations. Oversees team utilization of the CRM system (SalesForce.com) to record, document, and manage patient protected health information, ensuring data integrity and compliance. Establishes and maintains positive working relationships with current and potential customers, referral sources, and other company resources including Field Sales and Commercial Operations. Ensures the team practices and reflects knowledge of HIPAA, TJC, and other federal/state regulatory agencies affecting patients and our business; leads training and audits related to these standards. Maintains subject-matter knowledge of compliance requirements for federally funded healthcare programs (e.g., Medicare and Medicaid) regarding fraud, waste, and abuse. Escalates any questions or concerns regarding compliance to administrative staff and takes appropriate action on concerns reported by department staff related to compliance. Partners with Order Operations leadership on departmental reporting, staffing plans, and process/workflow development as the team and company scale. All other duties as assigned. Ethical Conduct Conflict Resolution & Problem Solving Education & Experience: At least five years of medical experience, including at least one to two years in a lead or supervisory capacity; preferably in home medical equipment. Previous health care or home care related Intake/Authorization experience required. Strong working knowledge of insurance requirements, coding, and coverage. Prior experience supervising or leading a team in a call center, intake, or benefits verification environment preferred. Physical Functions and Work Environment The physical functions described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions. While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers; handle or feel objects, tools, or controls. The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus. The noise level in the work environment is expected to be low to moderate. Note This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any Koya manager authorized to provide instruction or assign work. Duties, responsibilities, and activities may change at any time with or without notice. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an "at will" relationship. Koya Medical, Inc. is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.

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