Claims Processing Director jobs in Colorado

PharMerica

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 apply today!

Join our PharMerica team! PharMerica is a closed-door pharmacy where you can focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients. We offer a non-retail pharmacy environment. Our organization is in high growth mode, which means advancement opportunities for individuals who are looking for career progression!

Our Pharmacy group focuses on providing exceptional customer service and meeting the pharmacy needs for hospitals, rehabilitation hospitals, long-term acute care hospitals, and other specialized care centers nationwide. If your passion is service excellence and top-quality care come join our team and apply today!

We are seeking Claims Supervisors with 3^rd party claims experience. Pharmacy Technicians, with supervisory experience, seeking an alternative career move from the retail environment are desired

This is a remote position. Applicants can live anywhere within the continental USA.

Schedule: Monday-Friday, 8:30am to 5:00pm Central time Zone

We offer:

Competitive pay

Health, dental, vision and life insurance benefits

Company paid STD and LTD

Employee Discount Program

401k

Paid-time off

Tuition reimbursement

Non-retail/Closed-door environment

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 apply today!

*Position will be posted for a minimum of 7 business days

* 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.

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