Specialty Billing Coordinator

4 days ago

Atlanta, Georgia, United States Walgreens Full time

Job Summary

We are seeking a highly skilled and detail-oriented Specialty Billing Coordinator to join our team at Walgreens. As a key member of our billing team, you will be responsible for ensuring the accurate and timely submission of medical claims to payers.

Key Responsibilities

  • Submit accurate and timely invoices to payers for products and services provided.
  • Determine quantities and prices for products and services billed, ensuring compliance with regulatory requirements.
  • Verify services and products are correctly authorized and required documentation is on file.
  • Ensure all Medicare documentation is received from medical providers and submitted to Walgreens.
  • Review reports to maximize generic substitution opportunities and reduce costs.
  • Manage and collect patient balances prior to prescription dispensing, or in accordance with company policy.
  • Ensure all required documentation for billing is completed and accurate prior to claim submission.
  • Process reimbursement checks/payment in accordance with policy.
  • Review price modify logs and ensure there are corresponding SDL (submit direct link) claims.
  • Review, research, and resolve all third-party chargebacks in a timely manner.
  • Assist with any third-party audits, in accordance with company policy.
  • Process and file all SDL (submit direct link) claims in accordance with company policy.
  • Process prescription exceptions, including prior authorizations, triaging of referrals to other Walgreens locations, and proactively identifying copay assistance opportunities.
  • Responsible for proactive communication to patients and providers regarding referral/prescription status.
  • Responsible for maintaining a deep understanding of and assisting patients with assistance programs enrollment, such as Chronic Disease Fund, confirming patient eligibility and all required reporting and documentation.
  • Handles telephone calls that do not require personal attention of the pharmacist, including those to physicians and third-party payers.
  • Maintains subject matter expertise pertaining to all external billing practices, including but not limited to third-party adjudications, prior authorization, and patient financial assistance programs, in order to coach pharmacy technicians and other support staff.

Requirements

  • High School Diploma or equivalent.
  • Pharmacy Technician license, in states where required.
  • Maintains PTCB or ExCPT certification through the designated PTCB or ExCPT training program and/or state required certification/registration.
  • Experience communicating both verbally and in writing to various audiences.
  • Experience providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction.

Preferred Qualifications

  • Prefer six months of experience in a retail environment.
  • Prefer to have prior work experience with Walgreens.
  • Experience in processes related to submitting medical claims, including but not limited to Medicare submission, knowledgeable in EOB (explanation of benefits), remittance advice, and adherence to timely filing limits.
  • Experience entering data into databases (e.g., MS Excel).

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