Manager of Retrieval Operations
Remote
About Reveleer
Reveleer delivers a unified platform spanning risk adjustment, quality improvement, clinical intelligence, and member management for health plans and provider organizations navigating the complexity of value-based care. Trusted by 80+ customer organizations nationwide, the platform integrates data, analytics, and intelligent workflow automation into one governed system designed to support traceable documentation across diagnoses, quality measures, and submissions. With regulatory expertise and transparent, human-in-the-loop AI at its core, Reveleer supports organizations working to advance care quality, strengthen documentation integrity, and sustain the operational readiness needed to navigate audits with confidence.
POSITION OVERVIEW:
The Retrieval Manager leads day-to-day execution of Reveleer's retrieval program for one of Reveleer's largest and highest-visibility customer launches, covering approximately 500,000 chases beginning with the October 2026 go-live.
This role involves retrieval workflow, following standard processes/procedures/best practices, throughput, retrieval rate and pend performance, and AID-level escalation management for the book of business. It directs a blended retrieval model that pairs Reveleer's AI-enabled voice agents on the platform with human Patient Support Representatives, and it owns the staffing and capacity plans that keep both in balance against weekly chase volume.
This role also helps manage the customer and communicates performance, action plans and customer requirements.
WHAT YOU'LL DO:
Retrieval Execution & Chase Management
• Own daily and weekly execution of the chase queue, monitoring retrieval rate, pend rate, and AID ownership across roughly one million annual chases.
• Manage the chase-to-AID assignment structure and adjust workflows as volume and provider mix shift throughout the program.
• Drive resolution of aged and at-risk chases, escalating systemic barriers to retrieval before they affect SLA performance.
AI Agent-Enabled Workflow Oversight
• Oversee day-to-day performance of the platform voice agents supporting retrieval outreach.
• Monitor agent-to-human conversion and outcome metrics, and flag tuning opportunities that improve retrieval yield or reduce provider abrasion.
Capacity Planning & Staffing
• Maintain the PSR staffing model and capacity forecast, adjusting for chase volume, seasonality, and agent-enabled throughput gains.
• Partner with the India retrieval team to align onshore and offshore capacity against weekly chase intake.
• Recommend staffing changes ahead of volume shifts so the program stays within SLA without over- or under-staffing.
Customer & Cross-Functional Partnership
• Serve as the day-to-day operational point of contact for the retrieval relationship.
• Partner with Onboarding & Data Management on data quality issues that affect chase assignment or provider matching.
• Coordinate with Customer Support on provider- and member-facing escalations tied to retrieval outreach.
Performance Reporting & QBR Support
• Produce and maintain the Chase Status Underlying Report analysis, tracking retrieval percentage, pend rates, and escalation lists.
• Build weekly and monthly scorecards summarizing program health for Reveleer and customer leadership.
• Contribute customer-specific performance narratives and data to quarterly business review materials.
Escalation & Issue Resolution
• Lead root-cause analysis on retrieval shortfalls, provider access issues, or agent performance gaps.
• Establish escalation paths between Retrieval Services, Clinical Operations, and Engineering for production issues affecting chase completion.
• Drive corrective action plans to closure and confirm sustained improvement.
Process Improvement
• Identify opportunities to expand AI agent-enabled retrieval to additional chase types or provider segments within the program.
• Document and refine standard operating procedures for the blended agent and PSR retrieval model.
• Share lessons learned from the launch with peers supporting other RISK, HEDIS, and IVA programs.
ABOUT YOU:
• 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.
Preferred
• Direct experience with Medicare Advantage or ACA health plan customer.
• Experience in a business process outsourcing (BPO) or shared services operating model, including offshore team coordination.
WHAT YOU’LL RECEIVE:
• Competitive salary
• Medical, Dental and Vision benefits
• 401k with Employer Match
• Generous PTO plan
Our compensation reflects the cost of labor across several US geographic markets. Pay is based on several factors including market location and may vary depending on job-related knowledge, skills, and experience.
Reveleer E-Verifies all new hires.
Reveleer is an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, gender identity, sexual orientation, age, marital status, veteran status, disability status or genetic information, in compliance with applicable federal, state and local law.
