Senior Claims Team Lead — Denials & Training (Remote)

BrightSpring Health Services Corporation; Louisville (KY); Remote; USD 60,000 - 90,000; Full time

Benefits offered by this job

Medical, Dental, Vision insurance

Health Savings & Flexible Spending

Tuition discounts & reimbursement

401(k)

Company Paid Time Off

Shift Differential

DailyPay

Pet Insurance

Employee wellness and discountPrograms

Job summary

PharMerica, part of BrightSpring Health Services, seeks a 3rd Party Claims Specialist Team Lead to act as SME on denial research, assist with payer rules, and mentor staff. The role supports evening/weekend shifts in a remote setting across the United States, focusing on improving billing accuracy and compliance.

Responsibilities include staff training, performance feedback, and process improvements, with emphasis on Medicare Part D, Medicaid, and commercial billing.

Qualifications

• High School graduate, GED or equivalent experience.
• Desired: Associates degree, 4 year college or technical degree.
• 3+ years insurance billing experience.
• Specialized understanding of billing requirements (Medicare Part D, Medicaid, Commercial).
• Revenue cycle knowledge in pharmacy settings.

Responsibilities

• Trains and mentors staff to ensure training materials are used.
• Supports staff and promotes a positive environment.
• Provides feedback to supervisors for performance reviews.
• Identifies performance issues and discusses with Supervisor.
• Provides retraining and coaching to improve performance.
• Assists management with fair work distribution and workload balance.
• Reviews variances and write-offs for accuracy before Supervisor approval.
• Performs monthly quality assessments and reports findings.
• Maintains processing reports and generates necessary reports.
• Identify financial exposure and risk with non-performing payers.
• Keep up-to-date on third-party billing requirements.
• Monitor and support billing exception reports to ensure correct payer reimbursements.
• Complete billing transactions for non-standard orders when required.
• Educate management on payer-specific claim rules and guidelines.
• Proactively suggest process improvements within the department.

Skills

Analytical skills

Time management

Attention to detail

MS Office

Phone communication

Customer service

Problem solving

Teamwork

Education

High school diploma

Associates or higher

Tools

AS400

QS1

Frameworks

Job description

PharMerica, part of BrightSpring Health Services, seeks a 3rd Party Claims Specialist Team Lead to act as SME on denial research, assist with payer rules, and mentor staff. The role supports evening/weekend shifts in a remote setting across the United States, focusing on improving billing accuracy and compliance.

Responsibilities include staff training, performance feedback, and process improvements, with emphasis on Medicare Part D, Medicaid, and commercial billing.