Remote Claims Team Lead – Denials Expert

PharMerica; Louisville (KY); On-site; USD 65,000 - 90,000; Full time

Job summary

PharMerica, part of Brightspring Health Services, is seeking a 3rd Party Claims Specialist Team Lead to serve as SME on denial research methods and to mentor Claims Specialist I/II. The role involves night and weekend shifts with remote work options, focusing on payer-specific rules and timely billing.

The candidate will train staff, monitor performance, and help optimize processes across the team, ensuring compliant and accurate claims processing for a national healthcare provider.

Qualifications

• 3+ years insurance billing experience.
• Specialized understanding of Medicare Part D, Medicaid, and Commercial billing.
• Understanding of revenue cycle functions within pharmacy practice or equivalent setting.

Responsibilities

• Trains new employees and ensures all applicable training materials are provided and reviewed.
• Provides support to staff and acts as a mentor/coach to promote a positive environment.
• Provides feedback on all levels of staff to supervisor to be used in employees one on ones, check-ups and reviews.
• Identifies staff performance issues and discusses with Supervisor.
• Provides the necessary retraining or one on one support with staff to assist in meeting performance expectations.
• Assists management with fair distribution of work/site assignments and communicates when workloads are off balance.
• Reviews variances and write-offs submitted by staff for accuracy before approval.
• Performs monthly quality assessments on staff and reports training needs to Supervisor/Manager.
• Prepares and maintains reports and records for processing and runs miscellaneous reports as assigned.
• Identifies potential financial exposure and risk to the company with underperforming payers.
• Stays up to date on third-party billing requirements.
• Monitors and supports conversion of billing exception reports to ensure accurate assignment of claims.
• Completes billing transactions for non-standard order entry situations.
• Provides education to management and team members on payer rules and reimbursement guidelines.
• Takes initiative to find opportunities for process improvement within the department.

Skills

Analytical skills

Time management

Attention to detail

Communication

Customer service

Teamwork

Mentoring/Coaching

Education

High School diploma

Associates/Technical degree

4-year college degree

Tools

MS Office

AS400/Frameworks/QS1

Excel

CRM systems

Job description

PharMerica, part of Brightspring Health Services, is seeking a 3rd Party Claims Specialist Team Lead to serve as SME on denial research methods and to mentor Claims Specialist I/II. The role involves night and weekend shifts with remote work options, focusing on payer-specific rules and timely billing.

The candidate will train staff, monitor performance, and help optimize processes across the team, ensuring compliant and accurate claims processing for a national healthcare provider.