Healthcare Operations Support Specialist Lead (SCA)

ABOUT MACHINIFY:

In October 2025, Machinify acquired Performant and we are now part of the Machinify organization.  Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify’s AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy. We’re reshaping healthcare payment through seamless intelligence. 

ABOUT THE OPPORTUNITY:

The HCS Operations Support Services team performs activities to healthcare audit client inventory activities such as claim re-pricing, client inventory status reporting, responding to client inquiries, researches and resolves issues that may arise, and other client account ad-hoc reporting and inventory support activities. This Lead position serves as the team’s first point of escalation for Operations Support Representatives and Analysts, performs coordination and follow-up on regular operational inventory activities within Operations Support as well as broader audit team,  supports assigning team resources for ad-hoc reports and requests, supports team training for new team members, performs team quality assurance reviews, and other duties in support of the team and management to provide excellent services to our healthcare clients.

Key Responsibilities

• Serves as first point of escalation for questions and issues on the team. Use good judgment to inform and/or escalate to management as may be appropriate.

• Leverage knowledge and acumen in the medical billing and claims industry to provide actions-based solutions for clients, and answer staff questions.

• Assists in the gathering of information, data points, and current reporting tools to resolve any conflicts or concerns of claim discrepancies.

• Responsible for ensuring that regular data reporting from the team for internal business groups and for clients are delivered in accordance with schedule and scope. 

• Coordinates and follows-up with audit groups to monitoring data flow coming from selection team. Inform appropriate management and audit team members as appropriate for delays or issues.

• Reviews incoming requests for Ad Hoc reports, from varying resources, and assessing the skills and capabilities of the team, assigns the creation of the report to the employees.

• Creates and delivers scheduled and ad-hoc reporting on-time and with high quality.

• Contributes to special ad hoc report creation and analysis to create effective resolutions for client requests, inventory monitoring and management, medical records request letters, and other time sensitive work product.

• Monitors claim and case inventory reports and utilizes industry knowledge and company procedures to effectively assign case inventories to meet daily, weekly, and monthly work product objectives.

• Requests insights drawn from DPE spreadsheet queries, working with excel filter tools, and knowledge of DPE reporting to extract and assign needed.

• Provides some basic analytic review in event of client escalates concerns on re-pricing initiatives or determinations, and the client seeks solutions from data reporting.

• Participates in weekly and monthly communication and service focused meetings both internally with staff and as a knowledge participant for client calls, building working relationships of trust and reliability with client(s).   Responsible for reporting meeting outcomes, minutes, and accomplishments applicable to the team.

• Responsible for the on-the-job training of staff on work processes and tasks, standard operating procedures, system proficiency, and changes as applicable based upon internal or client requirements.

• Contribute to the development and/or improvement and administration of team productivity and Quality Assurance metrics and procedures.

• Monitor activity volume and staff capacity to ensure resources are aligned with business needs. Provide insights to management as may be needed for staff or workflow planning.

• Review team and individual productivity and quality against established metrics and identify potential issues or gaps, making recommendations to applicable supervisor or management on performance improvement needs.

• Other Duties as assigned.

Knowledge, Skills and Abilities Needed

• Well-rounded knowledge and skills specific to the medical claim billing, medical terminology, medical coding, re-pricing claims, along with some experience in basic medical data analytics

• Experience in some capacity of medical claim quality assurance, or past demonstrated experience in a QA function. Strong working proficiency with Microsoft Office suite.  Must have strong Excel skills and demonstrated ability to effectively leverage a multitude of templates, formats, and data spreadsheet tools.

• Strong technical skills – comfort working with databases and tools to extract and analyze data. Previous experience with various database tools such as DPE and others to organize information and reporting into value added work product. 

• Ability to communicate professionally both verbally and in written form with internal and external audiences.

• Good critical thinking, questioning, and listening skills.

• Time management skills to effectively manage diverse workload while completing work within allocated time frames in a fast-paced dynamic environment.

• Must have excellent organization skills and attention to detail.

• Ability to work independently, and work cooperatively within the team, providing strong understanding of workflows, claim escalations, reporting tools, and team training.

• Demonstrated ability to lead by example for operations staff demonstrating integrity, reliability, strong initiative and work ethic, work attendance, problem solving, and organization of work.

• Can meet objectives with minimal supervision.
   

Required and Preferred Qualifications

• High school degree or GED required. Some college, AS or BS degree is plus.

• Minimum 3 years of experience involving medical billing/claims required. Six (6) or more years preferred.

• Other requirements may apply.

WHAT WE OFFER:

Machinify offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually. For more information about our benefits package, please refer to our benefits page on our website or discuss with your Talent Acquisition contact during an interview.

Physical Requirements & Additional Notices:

If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required.  Proof of such may be required prior to an offer being made.  It is the Employee’s responsibility to maintain this Internet access at their home office location.

The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each individual job may vary.

• Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse.

• Regularly reads and comprehends information in electronic (computer) or paper form (written/printed).

• Regularly sit/stand 8 or more hours per day.

• Occasionally lift/carry/push/pull up to 10lbs.

Machinify is a government contractor and subject to compliance with client contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and other clearances (as applicable). As such, the following requirements will or may apply to this position:

• Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions).   Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions.

• Some positions may require the total absence of felony and/or misdemeanor convictions. Must not appear on any state/federal debarment or exclusion lists.

• Must complete the Machinify Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures.

• Other requirements may apply.

All employees and contractors for Machinify may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times.  Violations to Machinify's policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination.

Machinify is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Machinify will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you believe a reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact Machinify’s Human Resources team to discuss further.

Our diversity makes Machinify unique and strengthens us as an organization to help us better serve our clients. Machinify is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law.

THIRD PARTY RECRUITMENT AGENCY SUBMISSIONS ARE NOT ACCEPTED UNLESS EXPLICITY AGREED TO IN WRITING