Manager – Retrieval Operations

Job not on LinkedIn

🔥 5 minutes ago

🇺🇸 United States – Remote

💵 $60k - $80k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

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Reveleer

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare • Healthcare Insurance • SaaS

Reveleer is a healthcare technology company that specializes in providing an end-to-end platform for value-based care. Their platform leverages artificial intelligence to automate tasks, improve efficiency, and enhance patient care by consolidating risk adjustment and quality improvement workflows. Reveleer helps healthcare organizations streamline their operations through intelligent data acquisition, enhancing productivity and ensuring accurate reimbursement. With a focus on healthcare intelligence, Reveleer integrates with HIEs and EHR systems to improve care delivery and capture relevant diagnoses. They have a significant presence in the healthcare industry, working with various health plans to maximize their performance and patient outcomes.

📋 Description

• Lead day-to-day execution of Reveleer’s retrieval program for a major customer launch covering approximately 500,000 chases beginning with the October 2026 go-live • Own daily and weekly chase queue execution, monitoring retrieval rate, pend rate, and AID ownership across roughly one million annual chases • Manage chase-to-AID assignments and adjust workflows as volume and provider mix change • Resolve aged and at-risk chases and escalate systemic retrieval barriers • Oversee performance of AI-enabled platform voice agents supporting retrieval outreach • Monitor agent-to-human conversion and outcome metrics and identify tuning opportunities • Maintain PSR staffing models and capacity forecasts based on volume, seasonality, and agent-enabled throughput • Partner with the India retrieval team to align onshore and offshore capacity • Serve as the day-to-day operational point of contact for the retrieval relationship • Partner with Onboarding & Data Management on data quality and provider-matching issues • Coordinate provider- and member-facing retrieval escalations with Customer Support • Produce the Chase Status Underlying Report analysis and maintain retrieval, pend, and escalation tracking • Build weekly and monthly scorecards for Reveleer and customer leadership • Contribute performance narratives and data to quarterly business review materials • Lead root-cause analysis of retrieval shortfalls, provider access issues, and agent performance gaps • Establish escalation paths across Retrieval Services, Clinical Operations, and Engineering • Drive corrective action plans to closure and confirm sustained improvement • Identify opportunities to expand AI agent-enabled retrieval to additional chase types or provider segments • Document and refine standard operating procedures for the blended agent and PSR retrieval model • Share launch lessons learned with peers supporting other RISK, HEDIS, and IVA programs

🎯 Requirements

• 5+ years of experience in healthcare operations, chart retrieval, risk adjustment, or HEDIS/quality program management • 2+ years of experience directly managing a team of individual contributors, including performance management and coaching • Experience managing large-scale, high-volume retrieval or outreach programs against defined SLAs • Working knowledge of risk adjustment and HEDIS retrieval workflows, including chase, AID, and pend code concepts • Comfort working with AI-enabled or automated outreach tools, including monitoring performance and identifying tuning opportunities • Strong analytical skills, including proficiency in Excel; experience with Python or SQL for data analysis is a plus • Demonstrated ability to build and maintain staffing and capacity forecasting models • Excellent written and verbal communication skills, with experience presenting performance data to customers or senior leadership • Ability to manage multiple priorities in a fast-paced, deadline-driven environment • Direct experience with Medicare Advantage or ACA health plan customer (preferred) • Experience in a business process outsourcing (BPO) or shared services operating model, including offshore team coordination (preferred)

🏖️ Benefits

• Competitive salary • Medical, Dental and Vision benefits • 401k with Employer Match • Generous PTO plan