Andrew Holmes
Portland,OR
Summary
Lead Claims and Revenue Cycle Support operations for teams of 5-8, with responsibility for staffing support, onboarding, coaching, and daily workflow coordination. Maintain procedures, training materials, and performance tracking while partnering with leadership on audits, process updates, and quality improvements across both functions.
Overview
4
4
years of professional experience
Work History
Lead, Claims & Revenue Cycle Support
PharMerica
07.2024 - Current
- Lead daily operations across Claims and Revenue Cycle Support functions.
- Manage a team of 5-8 employees, adapting priorities to meet changing business needs.
- Partner with leadership to improve processes, quality outcomes, and operational performance.
- Train and onboard new team members while providing ongoing coaching and development.
- Created and maintained procedures, work instructions, documentation, and training materials to standardize operations.
- Support claims processing and Revenue cycle-related functions.
- Monitored performance through error logging and one-on-one sessions to identify and address areas for improvement.
- Demonstrated adaptability by becoming fully cross-trained and serving in lead roles across both Claims and Revenue Cycle Support departments.
- Assisted in hiring qualified employees
Claims Specialist
PharMerica
Portland , OR
09.2023 - 09.2024
- Resolved claim denials by coordinating with pharmacies, payers, and billing teams.
- Investigated claim discrepancies using payer guidelines and PharMerica internal systems.
- Communicated claim status updates to customers and internal PharMerica departments.
RCS specialist
PharMerica
Portland, OR
07.2022 - 09.2023
- Audited pharmacy claims for plan compliance and billing accuracy
- Identified claim errors in pharmacy benefit and reimbursement files
- Managed and maintained Hospice Spreadsheets as well as worked on hospice patients profiles.
- Reviewed medication profiles for insurance coverage, eligibility, and prior authorization needs.
- Coordinated pharmacy support with nursing staff, prescribers, and internal teams.
Education
Some College (No Degree) - CPhT Certification Program
Tyler Junior College
Troup, TXSkills
- Claims Operations
- Prior Authorizations
- Audits Process
- Error Resolution
- Performance Monitoring
- Procedure Documentation
- Team Leadership
- Staff Training & Development
- Talent Acquisition
Professional Licensing
- PTCB Cert# 30296823
- NABP# 862947
Additional Qualifications
- Fully cross-trained in Claims and Revenue Cycle Support.
- Participated in the Interview and Hiring Process for both departments
- Experience with audits, review writing, procedure writing, prior authorizations, and claims functions.
- Strong commitment to quality, accountability, and continuous improvement.
- Analyze claims rejections to identify issues and resolve them. Reached out to insurance companies when needed to ensure correct processing of claims.
- Maintained hospice spreadsheet and patient files
- Conduct audits and quality reviews to ensure accuracy, compliance, and process adherence.
Timeline
Lead, Claims & Revenue Cycle Support
PharMerica
07.2024 - Current
Claims Specialist
PharMerica
09.2023 - 09.2024
RCS specialist
PharMerica
07.2022 - 09.2023
Some College (No Degree) - CPhT Certification Program
Tyler Junior College