Claims Processing Supervisor

Job Description

Job Description

Overview

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 Claims Supervisor manages associates' assignments and work queues on a daily and weekly basis, ensuring the timely resolution of claims, accurate billing, and the effective distribution of work to support operational efficiency.

This is a remote opportunity . Applicants can live anywhere within the Continental USA.

Night Shift Schedule: 10:00pm to 6:30am eastern. Must be able to work eastern time zone hours.

The ideal candidate will have 3+ years direct supervisory experience along with 3rd party billing/collections experience.

REQUIRED: Long-Term Care adjudication experience

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

Responsibilities

• Works in conjunction with the 3rd Party Claims Manager to establish specific associate goals, department wide goals, performance tracking and quality assessment audits.
• Establish and maintain professional and effective relationship with staff, peers, payers and other stakeholders.
• Provides associates assignments and work queues on a daily and/or weekly basis. Including resolution, billing, and appropriate distribution of work.
• Monitors quality of work performed by all associates, including interaction and compliance.
• Holds regularly scheduled meetings with staff to discuss performance metrics and ensure employees are on track to meet their goals.
• Report to Manager any trends occurring with payers and/or processes
• Updates staff with communications and process changes as directed by 3rd Party Claims Manager, Director or Senior Management and insures compliance.
• Handles escalated calls from customers and payers to ensure proper resolution.
• Mentor and provide oversight of Team Leads and Associate II staff to insure they are adequately communicating staff training needs, shadowing staff when assigned, performing monthly quality assessment reviews, and taking a lead role in any special projects that may be assigned by Supervisor or Manager.
• Manages staff attendance and time sheets for payroll (Kronos) system. Assures staff is meeting attendance policies and reports any variations to Manager.
• In conjunction with feedback provided by Team Lead and/or Associate, monitor work performance including quality
• Ensure assignments are fair and balanced based on Team Lead/Associate level skills sets.
• Works to update, create and/or maintain Standard Operations Procedures for the department.
• Ensures Sarbanes Oxley (SOX) compliance on all variance, write-off and convert exception reports inclusive of adequate signatures are obtained.
• Proper storage of completed documents per Compliance policies.
• Performs other tasks as assigned.
• Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
• Works to update, create and/or maintain Standard Operations Procedures for the department.

Qualifications

Education/Learning Experience
• Required: Associates degree, 4 year college , technical degree or 4+ years equivalent experience
Work Experience
• Required: 3+ years direct supervisory experience
• Desired: 3rd Party Billing or collections/billing experience in the healthcare industry, AS400 computer systems experience or Pharmacy Technician.
Skills/Knowledge
• Required: Proficiency in MS Office Products (Excel, Word) and Basic computer knowledge
• Required: Ability to maintain confidentiality
• Desired: AS400 Computer Systems Experience
Behavior Competencies
• Required: Excellent communication skills, both written and oral
• Required: Problem solving and detail oriented
• Required: Strong time management, organizational skills and self-starter
• Required: Strong attendance and leadership