Lead, Mail Order Pharmacy

Advanced Rx Management; Florida; On-site; USD 65,000 - 95,000; Full time

Job summary

Advanced Rx Management, a leading mail order pharmacy services provider in Florida, seeks a Mail Order Pharmacy Lead to guide the reimbursement team and coordinate day-to-day operations. You will oversee billing, appeals, denials, and communications with insurers while driving performance improvement.

Responsibilities include coaching staff, reviewing claims, ensuring timely follow-up, and reporting outcomes to the Direct Manager of Revenue Cycle.

Qualifications

• Minimum of 2 years of experience in medical billing or healthcare reimbursement.
• Experience with Workers’ Compensation, Personal Injury, or pharmacy billing is preferred.
• Strong knowledge of ICD-10, CPT codes, EOBs, and insurance reimbursement processes.
• Previous leadership, mentoring, or team supervision experience is preferred.

Responsibilities

• Manage an assigned book of business, including billing, collections, appeals, denials, and claim follow-up.
• Process Workers’ Compensation and Personal Injury prescription claims.
• Review aging reports and conduct timely follow-up on unpaid, underpaid, and outstanding claims.
• Investigate claim denials, payment adjustments, notices of disallowance, and other reimbursement issues, and take appropriate action to obtain reimbursement.
• Prepare and submit appeals, reconsiderations, and disputes with the required supporting documentation.
• Review and correct claim information, including patient demographics, insurance information, diagnosis codes, and CPT codes.
• Monitor claim status and follow up with insurance carriers, adjusters, attorneys, and other applicable parties as needed.
• Serve as a resource for team members by answering questions and assisting with complex or escalated claims.
• Provide day-to-day coaching, guidance, and support to team members.
• Assist the Direct Manager of Revenue Cycle with monitoring team productivity, progress, performance, evaluations, and training needs.
• Help identify process improvements and opportunities to increase reimbursement, reduce denials, and improve overall team efficiency.
• Communicate reimbursement trends, recurring issues, concerns, and opportunities to management.
• Assist with onboarding and training new team members as needed.
• Maintain accurate and timely documentation of account activity and claim follow-up.
• Assist with special projects and other Revenue Cycle responsibilities as assigned.

Skills

Medical billing

Healthcare reimbursement

Leadership

Job description

Position Summary

The Mail Order Pharmacy Lead will manage an assigned book of business while providing day-to-day support, guidance, and leadership to the reimbursement team. This position works closely with the Direct Manager of Revenue Cycle to address team questions, monitor productivity and progress, provide coaching, and identify training and performance opportunities.

Key Responsibilities

• Manage an assigned book of business, including billing, collections, appeals, denials, and claim follow-up.
• Process Workers’ Compensation and Personal Injury prescription claims.
• Review aging reports and conduct timely follow-up on unpaid, underpaid, and outstanding claims.
• Investigate claim denials, payment adjustments, notices of disallowance, and other reimbursement issues, and take appropriate action to obtain reimbursement.
• Prepare and submit appeals, reconsiderations, and disputes with the required supporting documentation.
• Review and correct claim information, including patient demographics, insurance information, diagnosis codes, and CPT codes.
• Monitor claim status and follow up with insurance carriers, adjusters, attorneys, and other applicable parties as needed.
• Serve as a resource for team members by answering questions and assisting with complex or escalated claims.
• Provide day-to-day coaching, guidance, and support to team members.
• Assist the Direct Manager of Revenue Cycle with monitoring team productivity, progress, performance, evaluations, and training needs.
• Help identify process improvements and opportunities to increase reimbursement, reduce denials, and improve overall team efficiency.
• Communicate reimbursement trends, recurring issues, concerns, and opportunities to management.
• Assist with onboarding and training new team members as needed.
• Maintain accurate and timely documentation of account activity and claim follow-up.
• Assist with special projects and other Revenue Cycle responsibilities as assigned.

Qualifications

• Minimum of 2 years of experience in medical billing, healthcare reimbursement, or related field.
• Workers’ Compensation, Personal Injury, or pharmacy billing experience preferred.
• Strong knowledge of medical billing, collections, appeals, denials, EOBs, ICD-10, CPT codes, and insurance reimbursement processes.
• Previous leadership, mentoring, coaching, or team support experience preferred.

Physical Requirements

• Ability to sit and work at a computer for extended periods.
• Ability to use a computer, keyboard, mouse, telephone, and other standard office equipment.
• Ability to communicate effectively through telephone, email, and other electronic communication methods.
• Requires repetitive hand and wrist movements associated with computer and data-entry tasks.
• Ability to visually review electronic documents, spreadsheets, account information, and financial records for extended periods.

Standard Specifications

This job description describes the general nature and level of work and is not intended to be an exhaustive list of all duties, responsibilities, or requirements. Duties and responsibilities may change based on business needs. Employees may be assigned other job-related duties as needed.

This description does not create an employment contract, express or implied, or alter an at-will employment relationship, where applicable.

Equal Employment Opportunity

Advanced Rx Management LLC is an Equal Employment Opportunity (EEO) employer. We are committed to providing equal employment opportunities to all qualified applicants and employees without regard to legally protected characteristics under applicable federal, state, or local law. We provide reasonable accommodation to qualified individuals with disabilities and for other legally protected needs, as required by applicable law.