Lead, Mail Order Pharmacy

Advanced Rx Management•Sunrise, FL

About The Position

The Mail Order Pharmacy Lead manages an assigned book of business and provides day-to-day support, guidance, and leadership to the reimbursement team. Working closely with the Direct Manager of Revenue Cycle, this role addresses team questions, monitors productivity and progress, provides coaching, and identifies training and performance opportunities. The ideal candidate is organized, detail-oriented, professional, and knowledgeable in insurance billing, reimbursement, collections, appeals, and denials. The role handles complex claims while serving as a resource and mentor to team members. The position also helps identify process improvements and opportunities to increase reimbursement, reduce denials, and improve team efficiency. Duties may change based on business needs, and other job-related duties may be assigned. This description does not create an employment contract or alter an at-will employment relationship, where applicable.

Requirements

Minimum of 2 years of experience in medical billing, healthcare reimbursement, or a related field.
Strong knowledge of medical billing, collections, appeals, denials, EOBs, ICD-10, CPT codes, and insurance reimbursement processes.
Ability to sit and work at a computer for extended periods.
Ability to use a computer, keyboard, mouse, telephone, and other standard office equipment.
Ability to communicate effectively through telephone, email, and other electronic communication methods.
Ability to perform repetitive hand and wrist movements associated with computer and data-entry tasks.
Ability to visually review electronic documents, spreadsheets, account information, and financial records for extended periods.

Nice To Haves

Workers’ Compensation, Personal Injury, or pharmacy billing experience.
Previous leadership, mentoring, coaching, or team support experience.

Responsibilities

Manage an assigned book of business, including billing, collections, appeals, denials, and claim follow-up.
Process Workers’ Compensation and Personal Injury prescription claims.
Review aging reports and timely follow up on unpaid, underpaid, and outstanding claims.
Investigate claim denials, payment adjustments, notices of disallowance, and other reimbursement issues, and take appropriate action to obtain reimbursement.
Prepare and submit appeals, reconsiderations, and disputes with required supporting documentation.
Review and correct claim information, including patient demographics, insurance information, diagnosis codes, and CPT codes.
Monitor claim status and follow up with insurance carriers, adjusters, attorneys, and other applicable parties as needed.
Serve as a resource for team members by answering questions and assisting with complex or escalated claims.
Provide day-to-day coaching, guidance, and support to team members.
Assist the Direct Manager of Revenue Cycle with monitoring team productivity, progress, performance, evaluations, and training needs.
Help identify process improvements and opportunities to increase reimbursement, reduce denials, and improve overall team efficiency.
Communicate reimbursement trends, recurring issues, concerns, and opportunities to management.
Assist with onboarding and training new team members as needed.
Maintain accurate and timely documentation of account activity and claim follow-up.
Assist with special projects and other Revenue Cycle responsibilities as assigned.