Supervisor of IDRE Operations

Job description

Position summary
Supervises the day-to-day execution of PRI's IDRE Operations team, ensuring work is completed accurately, efficiently, and in accordance with CMS requirements and organizational service level expectations. Responsible for production management, workforce planning, coaching, quality performance, and overall operational results. Partners with leadership and subject matter experts to implement operational standards, communication protocols, and continuous process improvements across the team.

Essential functions
*Supervise Team Leads and IDRE processing staff
*Own daily IDRE operational performance - throughput, CMS deadline compliance, and quality metrics
*Escalate complex issues through established leadership and subject matter expert channels, ensuring timely implementation of approved guidance, decisions, and process changes
*Conduct regular team meetings, one-on-ones, and performance conversations
*Monitor production KPIs and staffing levels
*Manage staffing allocation across case queues based on volume and priority
*Partner with QA on quality findings and manage corrective actions
*Execute operational changes resulting from audits, regulatory updates, and process improvement initiatives

Minimum qualifications
*5+ years of experience working in a regulated healthcare, insurance, payer, provider, revenue cycle, utilization management, appeals, claims, or similar production environment.
*1+ years of supervisory experience leading teams in a production or service operations setting.
*Experience managing operational performance through production, quality, timeliness, and service level metrics.
*Demonstrated ability to coach and develop employees while managing performance and accountability.
*Experience implementing standardized processes, operational procedures, and continuous improvement initiatives.
*Strong analytical and organizational skills with the ability to prioritize work across multiple queues and changing business needs.
*Excellent written and verbal communication skills with the ability to collaborate across operations, quality, compliance, and leadership teams

Preferred qualifications
*Experience supporting the No Surprises Act (NSA) Independent Dispute Resolution (IDR) process, CMS programs, or other federal or state healthcare regulatory programs.
*Bachelor's degree in healthcare administration, business, public administration, or a related field
*Knowledge of CMS regulations, healthcare reimbursement, managed care, utilization review, provider relations, or health plan operations.
*Experience using operational dashboards and workflow management systems to monitor production and performance.

This job description is not an employment contract and is subject to change. PRI is an equal opportunity employer.