3Rd Party Claims Processing Supervisor

Phar Merica

Are you the super-star multitasker type, strong in administration skills? Our Administrative and Clerical positions support the business from multiple locations and via various functions across the nation. Read below for information on this opportunity and

Schedule:

Monday - Friday Evening and Weekends

Remote Positions

• Competitive Pay
• Health, Dental, Vision & Life Insurance
• Company-Paid Short & Long-Term Disability
• Flexible Schedules & Paid Time Off
• Tuition Reimbursement
• Employee Discount Program & Daily Pay
• 401k
• Pet Insurance

• 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.

• Required:
  
  Associates degree, 4 year college , technical degree or 4+ years equivalent 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

• Required:
  
  Proficiency in MS Office Products (Excel, Word) and Basic computer knowledge
• Required:
  
  Ability to maintain confidentiality
• Desired: AS400 Computer Systems Experience

• 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

Phar Merica, an affiliate of Bright Spring 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'…