Remote Claims Team Lead - Denials & Training Expert

BrightSpring Health Services Corporation; Louisville (KY); Remote; USD 60,000 - 85,000; Full time

Benefits offered by this job

Medical, Dental, Vision insurance

Health Savings & Flexible Spending (up

Tuition discounts & reimbursement

401(k)

Company Paid Time Off*

Shift Differential

DailyPay

Pet Insurance

Employee wellness and discount 프로그램

Job summary

PharMerica, part of BrightSpring Health Services, seeks a 3rd Party Claims Specialist Team Lead to drive denial research, mentor staff, and ensure compliant, accurate payer billing across Medicare Part D, Medicaid, and commercial plans. This remote, evening/weekend role supports the Claims Specialist I and II, guiding training and performance.

The role emphasizes training delivery, process improvement, and reliable reporting while supporting a positive, compliant work environment.

Qualifications

• High school graduate or GED required; associates degree or higher desirable.
• 3+ years of insurance billing experience with understanding of Medicare Part D, Medicaid and Commercial billing.
• Experience with revenue cycle functions in pharmacy practice or equivalent setting.

Responsibilities

• Trains new employees and ensures training materials are provided and reviewed.
• Provides support to staff and mentors to promote a positive environment.
• Gives feedback to supervisors and participates in employee one-on-ones and reviews.
• Identifies staff performance issues and coordinates retraining as needed.
• Distributes work fairly and communicates workload balance to improve效率.
• Reviews variances and write-offs for accuracy before supervisor approval.
• Performs monthly quality assessments and identifies training needs.
• Prepares and maintains processing reports and ad hoc reports.
• Identifies financial exposure and risk with underperforming payers.
• Keeps up to date on third‑party billing requirements.
• Monitors and supports conversion of billing exception reports to ensure timely billing.
• Completes billing transactions for non-standard order entry situations.
• Educates management and staff on payer-specific rules and reimbursements.
• Suggests process improvements within the department.

Skills

Strong analytical skills

MS Office (Excel, Word)

Time management

Communication & teamwork

Problem solving

Education

High School graduate or GED

Associates or higher (desirable)

Tools

AS400

QS1

Frameworks

Excel

Job description

PharMerica, part of BrightSpring Health Services, seeks a 3rd Party Claims Specialist Team Lead to drive denial research, mentor staff, and ensure compliant, accurate payer billing across Medicare Part D, Medicaid, and commercial plans. This remote, evening/weekend role supports the Claims Specialist I and II, guiding training and performance.

The role emphasizes training delivery, process improvement, and reliable reporting while supporting a positive, compliant work environment.