PharMerica, a part of Brightspring Health Services, is a long‑term care pharmacy services provider that supplies medications, clinical support, and pharmacy management to healthcare organizations across the United States.

The 3rd Party Claims Specialist Team Lead is a subject matter expert (SME) on the company’s denial research methods, internal and external databases, reporting tools and policies and procedures. The Team Lead is a SME on all types of denials and functions performed by both the Claims Specialist I and Claims Specialist II and acts as a trainer and mentor to both.

Shift: Nights and Weekends 

Remote position 

Benefits and perks for You!    

• Medical, Dental, Vision insurance   
• Health Savings & Flexible Spending Accounts (up to $5,000 for childcare)   
• Tuition discounts & reimbursement   
• 401(k) 
• Company Paid Time Off*
• Shift Differential 
• DailyPay
• Pet Insurance
• Employee wellness and discount programs 

*Benefits may vary by employment status   

• 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 discuss with Supervisor
• Provides the necessary re-training or one on one support with staff to assist in meeting the performance expectations
• Assists management with fair distribution of work/site assignments being sure to communicate when the workloads are off balance and make suggestions on how to reconcile
• Reviews variances and write-offs submitted by staff for accuracy of information and approval requirements before giving to Supervisor for approval
• Performs monthly quality assessments on staff to ensure accuracy. Report any identified training needs to Supervisor and Manager for further review and follow-up action plan as needed
• Prepares and maintain reports and records for processing as well as run and produce miscellaneous reports as assigned or necessary
• Identifies potential financial exposure and risk to the company with underperforming or non-compliant payers
• Stays up to date on third-party billing requirements
• Monitors and provide support to those assigned to work convert billing exception reports to ensure claims are billed to accurate financial plans timely
• Completes billing transactions for non standard order entry situations as required
• Provides education to management and team members on payer specific claim processing rules, reimbursement, and other policy guidelines as gleaned by, and confirmed through working directly with payers
• Takes initiative to find opportunities and make suggestions for process improvement within the department

EDUCATION/EXPERIENCE
• 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 in one of the following areas: Medicare Part D, Medicaid, and Commercial billing.
• Understanding of revenue cycle functions within pharmacy practice or equivalent setting.

LICENSE/CERTIFICATION/OTHER SPECIAL REQUIREMENTS
• Desired: Pharmacy Technician.

KNOWLEDGE/SKILLS/ABILITIES
• Strong analytical skills, excellent time management and attention to details.
• Working knowledge in MS Office Products (Excel, Word) and basic computer knowledge.
• Comfortable making phone calls and interacting with internal/external entities.
• AS400, Frameworks or QS1, Computer Systems Experience.
• Communication, problem solving, detail oriented and teamwork, customer service, and accuracy.
• Strong organization skills, self-starter, and confidence.
• Must be a positive mentor to all staff.

*This position will require sitting, standing, and walking. It will also require frequent typing on a keyboard. Ability to push/pull 21-30 lbs, and carry up to 21-30 lbs.*

At BrightSpring Health Services, our LEGACY culture guides how we lead, how we serve, and how we show up for one another. We are committed to doing the right thing—leading with integrity, accountability, and transparency in all that we do. As part of this commitment, we share that we may use third-party artificial intelligence (AI) to process employment data in connection with our hiring processes. Any AI tool that we use always has humans in the loop; we do not use AI to automate employment decisions or to discriminate, and we do not use zip codes as proxy. Humans – our hiring leaders and recruiter – make final decisions. BrightSpring Health Services provides reasonable accommodations to qualified applicants and employees with disabilities; if you would like to request a reasonable accommodation, please contact your recruiter or send an inquiry to TalentAcquisition@brightspringhealth.com. For more information about how our company uses AI in the hiring process, contact TalentAcquisition@brightspringhealth.com.

BrightSpring Health Services and its affiliated companies provide equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

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