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Supervisor, 3rd Party Claims Reconciliation

Date: Dec 12, 2018

Location: Brockton, MA, US

Company: PharMerica

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PharMerica Corporation is a premier institutional pharmacy services provider, dedicated to providing quality patient care and innovative pharmacy solutions to institutional customers and patients in long-term care settings. With nearly $2 billion in annual revenues, PharMerica is one of the nation's largest institutional pharmacy companies. PharMerica operates more than 100 institutional pharmacies in 45 states and serves nursing facilities that care for approximately 350,000 patients.




Supervises 3rd Party Claims Reconciliation staff, on a daily basis, to maximize collections of all open accounts receivable, resolving AR issues (unpaid accounts or identifying payer recoupments) and ensuring the achievement of company and departmental goals for all areas of claims reconciliation.  Supervisor mentors and supervises all staff to ensure training, quality work, productivity and performance expectations are maximized.


Essential Functions

•             Manage work flow and productivity of Associate 1 and Associate 2 staff. 

•             Provides associates agings assignments and work queue on a monthly basis.  Including:

o             Managing monthly plan assignments to associates by PBM alignment

o             Insure balance of AR work is evenly distributed based on associates knowledge and skill set

•             Monitors quality of work performed by associates – which includes: 

o             Internal and External Interactions (verbal and electronic)

o             Evaluate and monitor associates ability to provide necessary and vital detail regarding open AR issues during investigation stages.

o             Insures conclusions made by associate to resolve open AR issues are sound and correct.

o             Reviews at month end - aging spreadsheets for completeness, work load and quality assessments. 

o             Evaluates associates effectiveness in reducing financial exposure and loss to the company.

•             Report to Manager any variations or unusual activity in AR or underperforming payors.

•             Reviews status of delinquent accounts with associates to ensure compliance with collection goals.

•             Insures timely monthly billing of manual bill customers (Hospice/Workman’s Comp/Auto Claims). 

•             Updates staff with communications and process changes as directed by 3rd Party Claims Reconciliation Manager, Director or Senior Management and insures compliance. 

•             Works in conjunction with the 3rd Party Claims Reconciliation Manager to establish specific associate goals, department wide goals, performance tracking and quality assessment audits.

•             Handles escalated collection calls from customers and payors to ensure proper resolution.

•             Mentors and provides oversight of Associate I and 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 (Day Force) system.  Assures staff is meeting attendance policies and reports any variations to Manager.

•             Ensures SOX compliance on all variance and write-off (bad debt) and adequate signatures are obtained (based on dollar thresholds) – as well as – 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.

•             To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required.  Each essential function is required, although reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


Position Qualifications

•             Education/Learning Experience

             Required: High School graduate, GED or equivalent experience

             Desired: Associated Degree, 4 year college or technical degree

•             Work Experience

             Required: 1 year claims reconciliation and/or collections experience 

             Desired: Third Party Billing or collections/billing experience in the healthcare industry

             Desired: AS-400 computer experience.

•             Skills/Knowledge

             Required: Microsoft Suite Package Experience (Basic Level)

             Desired: AS400 Computer Systems Experience, typing skills and Excel Spreadsheet experience

•             Behavior Competencies

             Required: Communication, Problem Solving, Detail Oriented and Teamwork, Customer Service, and Accuracy.

             Desired: Strong attendance, organization skills, self-starter, and confidence



Accelerate Your Career with PharMerica!

Nearest Major Market: Brockton
Nearest Secondary Market: Boston

Apply now »