Location: Nashville, TN
Company: Walgreens
and services billed. Verify services and products are correctly authorized and required documentation is on file. Ensure all Medicare documentation is received from the medical provider and submitted to Danville. Review reports to maximize generic substitution opportunities.
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 (i. e. medical claims billing). 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.
Processing of 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 shop technicians and other support staff. External Basic Qualifications High School Diploma or equivalent. shop Technician license, in states where required. Maintains PTCB or Ex CPT certification through the designated PTCB or Ex CPT training program and/or state required certification/registration.
Experience communicating both verbally (on phone, one-on-one, to groups) and in writing (emails, letters, reports, presentations) to various audiences (work group, team, company management, prospective acquisitions, external clients). 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). The following information is applicable for San Francisco, CA applicants: Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. An Equal Opportunity Employer, including disability/veterans. The actual compensation that you will be offered will depend on a variety of factors including geography, skills and abilities, education, experience and other relevant factors.
To review benefits, please visit jobs. /benefits PDN-9ad38dac-8acf-4742-a748-50a87d5830b0
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Other Jobs is a broader category encompassing a variety of employment positions that do not necessarily fit into standard job classifications. This can include temporary gigs, rare professions, or emerging roles that are still defining their place in the job market. The primary characteristic of Other Jobs is their diversity, offering opportunities that might be unique, unconventional, or highly specialized. Another feature of such jobs is their flexibility, which often attracts individuals seeking non-traditional work schedules or the freedom to pursue multiple interests simultaneously.
Other Jobs is a comprehensive category that encompasses a diverse range of employment opportunities outside of the standard or mainstream career paths. These jobs may include gigs, freelance work, or unique roles in various industries that don't fit conventional job descriptions. The key features of Other Jobs include flexibility, non-traditional work environments, and often, the necessity for a creative or entrepreneurial mindset. They cater to individuals seeking alternatives to the nine-to-five routine, offering the chance to pursue passions or balance work with other life commitments.
