Mail-Order Pharmacy Reimbursement Lead

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

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.