Assistant Team Lead US Healthcare

MedNexus is a leading provider of end-to-end Revenue Cycle Management (RCM) and patient access solutions for healthcare providers across the United States. We are currently seeking a detail-oriented Assistant Team Lead to support daily front-end operations. This role involves guiding specialists through complex eligibility checks, maintaining high audit scores, and preventing downstream claim denials to ensure smooth and efficient patient access workflows.

Key Responsibilities

Operational Floor Support: Assist in assigning daily workloads and monitor real-time verification queues to ensure all eligibility and prior authorization requests are completed before patient appointments.

Subject Matter Expert (SME) Guidance: Act as the first-line SME to help specialists resolve complex insurance coverage questions, co-pay and deductible discrepancies, secondary payer rules, and coordination of benefits (COB) issues.

Prior Authorization and Pre-Certifications: Support the team in tracking and securing prior authorizations, pre-determinations, and medical necessity requirements with both commercial and government payers.

Quality Assurance and Auditing: Conduct routine quality audits on verified patient accounts to ensure accurate data entry into provider EHR/PMS systems, thereby preventing authorization-related denials.

Payer Portal Management: Monitor updates to payer policies (including Medicare, Medicaid, BCBS, Aetna, Cigna, UHC) and train team members on new eligibility verification guidelines and clearinghouse tools.

Required Qualifications

Experience: Minimum of 3+ years of hands-on experience in US Healthcare Verification of Benefits (VOB), Patient Access, or Insurance Eligibility.

Domain Knowledge: Strong understanding of US health plans such as PPO, HMO, EPO, POS, Medicare, and Medicaid, including co-insurance calculations, out-of-pocket maximums, and prior authorization workflows.

Technical Skills: Proficient in navigating real-time 270/271 EDI eligibility transactions, insurance web portals like Availity and Optum, and clearinghouses.

Software Proficiency: Experience working with major EHR/PMS platforms such as Athenahealth, eClinicalWorks, AdvancedMD, and strong skills in Microsoft Excel.

Shift Availability: Willingness to work shifts aligned with US business hours (EST/CST), including night shifts.

Preferred Qualifications and Benefits

MedNexus offers a competitive salary package complemented by performance bonuses. Employees receive comprehensive health and insurance coverage, paid time off (PTO), and holiday leave. There is a clear career progression path, with opportunities to advance to full Team Lead and Operations Manager roles.

This position requires in-person attendance at our office located in Rawalpindi, with night shift schedules. Candidates should be able to commute accordingly.

Applicants will be asked to confirm their experience in US Healthcare Verification of Benefits and Patient Access, current and expected salary, notice period requirements, and commuting feasibility for the night shift.

If you are a proactive professional with a strong background in healthcare eligibility verification and team leadership, this role offers an excellent opportunity to grow within a dynamic and supportive environment.