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Claims Processing Supervisor

PharMerica -
Louisville, KY

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Job Details

Full-time
13 days ago

Benefits

Health insurance
Dental insurance
401(k)
Flexible spending account
Paid time off
Vision insurance
Employee discount
Pet insurance

Qualifications

Computer operation
Confidential information handling
Serving clients
Team supervision
Standard Operating Procedures (SOPs) implementation
Word processing
Computer literacy
Writing skills
Regulatory compliance
Employee relationship building
Shift management
Performance feedback (performance evaluation method)
Metrics Reporting
Mid-level
SOX
Improving operational efficiency
Pharmacy technician experience
Job shadowing (employee development activity)
3 years
Quality control audit
Quality assurance audits
Employee attendance management
Team training
Compliance documentation
Mentoring
AS400
Organizational skills
Leading team collaboration initiatives
Healthcare quality audits
Managing insurance claims teams

Full Job Description

Our Company:

PharMerica

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

About our Line of Business: PharMerica, an affiliate of BrightSpring Health Services, delivers personalized pharmacy care through dedicated local teams, serving health care providers such as skilled nursing facilities, senior living communities, and hospitals. We also cater to individuals with behavioral needs, infusion therapy needs, seniors receiving in-home care, and patients with cancer. Operating long-term care, home infusion, and specialty pharmacies across the nation, we combine the personal touch of a neighborhood pharmacy with the resources of a national network. Our comprehensive solutions, backed by industry-leading technology and regulatory expertise, ensure accurate medication access, cost control, and compliance with best-in-class clinical standards. We are committed to enhancing resident health, reducing staff burdens, and supporting our clients' success. For more information, visit www.pharmerica.com. Follow us on Facebook, Twitter, and LinkedIn.

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