Assembly Health

General

• Obtain and manage prior authorizations for Spravato and TMS services from commercial and government insurance plans
• Ensure timely submission of required clinical documentation, including medical necessity letters, progress notes, rating scales, and treatment plans
• Review payer-specific medical policies to determine criteria for Spravato and TMS coverage
• Coordinate with providers, clinical staff, and billing teams to ensure complete and accurate information is submitted
• Track and follow up on authorization requests, denials, appeals, and renewals
• Maintain detailed records of payer communication, submission timelines, and authorizations received
• Support new customers during their start-up phase by navigating authorization processes and clinical documentation
• Stay current on changes in insurance requirements, payer policies, and clinical documentation standards
• Take on additional projects and tasks as assigned

UR Coordinator

Medical Director

• Develop and execute a strategic business development plan
• Identify, develop, and close new business opportunities
• Build relationships with executive decision-makers
• Maintain an active sales pipeline

Clinical Sales Director

Compliance

• Serve as trusted regulatory and operational advisor to skilled nursing and assisted living providers nationwide.
• Monitor, interpret, and communicate industry regulations, reimbursement updates, and emerging trends impacting post-acute care organizations.
• Independently stay ahead of healthcare industry changes and analyze operational and regulatory impacts across all levels of SNF and AL organizations.
• Develop and deliver timely educational content including webinars, presentations, training materials, videos, and industry resources.
• Create thought leadership content through social media engagement, industry articles, client communications, and conference participation.
• Respond to client regulatory and operational questions through the Polaris Group Solution Center hotline and email while ensuring exceptional customer service.
• Conduct regulatory research and provide timely guidance to consultants and clients regarding evolving industry requirements and best practices.
• Perform offsite and onsite medical record reviews, regulatory assessments, and episodic consulting visits as directed.
• Analyze client data and prepare comprehensive reports with actionable recommendations and follow-up strategies.
• Review consultant site visit reports for regulatory accuracy and quality assurance.
• Maintain accurate documentation, reports, calendars, and Solution Center records in accordance with company standards.
• Build strong client relationships through responsive communication, strategic guidance, and professional support.
• Collaborate with internal teams on product development, educational initiatives, and consulting strategies.
• Represent Polaris Group through conferences, speaking engagements, webinars, and professional industry events.
• Identify opportunities for additional consulting services and collaborate with the sales team to support client growth and retention.
• Participate in and lead special projects that support business initiatives, innovation, and organizational growth.
• Perform additional duties and strategic initiatives as assigned to support the evolving needs of the business.

Senior Regulatory Consultant

Vice President

• Own and deliver on the agreed-upon P&amp;L targets. Oversee budgeting, financial planning and cost control processes to ensure the BU’s financial health and profitability.
• Develop and execute strategic plans to achieve the desired business goals, aligning to company and Physician RCM division initiatives.
• Provide regular financial and operational updates and performance reports to the senior leadership team via Monthly Operating Reviews and other means.
• Oversee day-to-day RCM operations to ensure the BU is running smoothly and delivering the desired financial, customer and employee engagement results
• Maintain internal performance reporting and dashboards and analyze metrics, trends and the competitive landscape to identify opportunities for growth and margin expansion.
• Develop and implement operational processes to increase productivity, reduce costs and improve overall BU performance.
• Continuously identify areas for process improvements and opportunities to scale the business unit and implement changes to enhance overall performance.
• Partner with the Head of Physician RCM to manage BPO partnerships and assure the partner’s operations consistently achieve the agreed-upon performance targets.
• Partner with Head of Physician RCM to consolidate and restructure the business units into specialty verticals and transition services to Assembly Health’s preferred offshore partners.
• Attract, retain and develop high-performing account management team.
• Foster a culture of high performance and continuous improvement within the named business unit.
• Identify and develop top talent and next-level leaders
• Partner with Human Resources to identify and execute employee engagement programs.
• Ensure that customer service and satisfaction are at the forefront of all business activities.
• Identify and execute programs to mitigate customer churn risk
• Support the team with addressing and resolving customer issues and service gaps
• Build and maintain strong relationships with key clients to support business growth
• Collaborate with sales and marketing to develop and implement strategies that enhance brand awareness and attract new customers
• Coordinate with sales team to drive growth and provide expertise where necessary
• Provide other support to sales opportunities, e.g., subject matter expertise, price modeling, margin analyses, contract review and edits, etc.

Vice President, Physician RCM

Account Manager

• Serve as the primary point of contact for assigned clients, addressing inquiries and concerns proactively
• Build and maintain strong relationships with healthcare providers and stakeholders
• Conduct regular client meetings to review RCM performance, discuss challenges, and align on financial goals
• Provide ongoing education to clients on RCM processes, industry trends, and regulatory changes
• Monitor and analyze key performance indicators (KPIs) such as Days Sales Outstanding (DSO), Denial Rates, AR Aging, and Net Collections
• Identify trends and implement solutions to optimize revenue collection and minimize delays
• Collaborate with internal billing, coding, and collections teams to ensure timely claims submission, payment posting, and follow-ups
• Address payer issues, reimbursement challenges, and operational bottlenecks
• Develop and execute action plans to improve financial outcomes for clients
• Ensure compliance with industry regulations (HIPAA, CMS, payer policies) and best practices
• Provide detailed reporting and insights on revenue cycle health
• Partner with leadership to refine workflows and enhance efficiency
• Investigate and resolve client issues related to claims, payments, or system inefficiencies
• Work cross-functionally with internal teams to drive process improvements
• Identify automation and technology enhancements to streamline operations

RCM Account Manager

Call Center Representative

• Greet our patients in a friendly and positive manner.
• Discuss and answer customer questions with a goal of one call resolution.
• Updating confidential information and insurance billing.
• Process credit card payments.
• Manage tasks within our internal work queues updating information as necessary.
• Respond to website patient inquiries via phone call to discuss concerns and provide resolution.
• Work with collection agencies to update and provide accurate information.
• Respond to Attorney requests for balances and correspondence as well as update and bill insurance.
• Complete workflow for patient self-pay accounts, reviewing correspondence, posting payments and resolving any concerns.

Medical Billing Representative

• Complete soft checks and Green VOBs
• Accurately review and verify patient eligibility
• Properly document and relay benefit information
• Respond to email correspondence promptly
• Ensure all benefit verifications are entered accurately

Behavioral Health VOB Specialist

• Develop and execute a strategic business development plan
• Identify, develop, and close new business opportunities
• Build relationships with owners, executives, and decision-makers
• Generate new business through networking and thought leadership
• Conduct discovery meetings to understand customer challenges
• Develop trusted relationships with executive leaders in the Skilled Nursing industry

Sales

• Drive New Business Growth
• Build and manage a strong pipeline of qualified opportunities using a disciplined sales process
• Effectively communicate Assembly Health’s value proposition to executive-level decision-makers at Private Practices and/or Physician run organizations.
• Develop and execute a strategic territory plan focused on high-value prospects in the region.
• Build a pipeline through combination of outbound prospecting, professional networking, client referrals, and collaboration with Marketing.
• Leverage market insights, industry trends, and competitor intelligence to prioritize accounts and optimize outreach.
• Engage in deep discovery to understand each client’s financial and operational challenges.
• Tailor RCM solutions to meet the unique needs of physician groups, behavioral health providers, or skilled nursing facilities.
• Partner closely with marketing, operations, and client success teams to ensure smooth onboarding and long-term satisfaction.
• Maintain a clean and up-to-date CRM (Salesforce or HubSpot) with accurate data and forecasts.
• Stay current on healthcare reimbursement trends, payer regulations, and RCM innovations.

RCM Sales Director

Credentialing Specialist

• Complete enrollment/credentialing and re-credentialing applications
• Maintain a detailed log of all pending and completed work
• Communicate the results and status of the applications to physicians, payers, managers, and co-workers.
• Maintenance of physician enrollment and CAQH profiles
• Documentation within enrollment database
• Coordinate signatures
• Payer processing and research
• Involves extensive phone work and internet.
• Research and resolve claim issues related to physician enrollment.
• Other tasks as needed.

• Support RCM Account Managers with client inquiries and identify areas of improvement.
• Oversee and provide coaching to a multi-disciplinary team of offshore team members.
• Complete complex denials follow-up and appeals and support AR management and payment posting functions.
• Identify, investigate, and resolve unpaid claims.
• Research and resolve payment and adjustment discrepancies.
• Submit claims’ reconsiderations and appeals.
• Research payer policies.
• Resolve patient queries and verify insurance coverage.
• Present reports to Account Managers informing them of offshore KPIs and A/R health status.
• Other tasks as needed.

RCM Team Lead

• Serve as the first point-of-contact for team members needing assistance with their day-to-day claim follow-up and questions
• Provide continuous education and mentorship to peers
• Share expertise, best practices, and strategies for effective collection and claim follow up
• Ensure accurate documentation of collection activities
• Assist team members with proper record-keeping practices and ensuring collection processes are followed as outlined in the organization's SOP. Help team members set and achieve their individual performance goals
• Collaborate with insurance providers to monitor outstanding claim status and navigate resolution steps
• Investigate outstanding A/R accounts, determine the cause of the delinquency, and collect payments
• Submit and re-submit claims and conduct follow-up calls ensuring thorough documentation
• Review all documentation the client provides and identify discrepancies
• Contribute to the preparation and the assignment of collection work queues
• Perform daily QA reviews on AR Specialists quantity and quality of work on their assigned accounts
• Identify trends and conduct root cause analyses on unpaid and underpaid claims
• Create monthly reports using Excel that outline insurance denial trends and share with internal management
• Achieve performance goals or objectives (individual or departmental) as established by the Manager
• Maintain HIPAA and compliance standards to preserve patient confidentiality
• Other tasks as needed and assigned

UR Coordinator

Clinical Sales Director

Senior Regulatory Consultant

Vice President, Physician RCM

RCM Account Manager

Medical Billing Representative

Behavioral Health VOB Specialist

Clinical Sales Director

RCM Sales Director

Credentialing Specialist

RCM Team Lead

Behavioral Health AR Team Lead