Primary Duties

• Submit timely, accurate invoices to payer for products and services provided.
• Correctly determine quantities and prices for products 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 pharmacy technicians and other support staff.