Analyst, Billing - DS (Pharmacy Audit)
About The Position
The Billing Analyst supports pharmacy billing compliance by responding to third‑party payer audit requests, researching claim details, and assisting with appeal documentation. This audit role helps identify trends, mitigate billing risk, and ensure pharmacy billing practices align with payer and regulatory requirements. About the Team You will be part of the Health & Wellness Billing team, which supports pharmacy operations by responding to third‑party payer audits and investigations. The team works closely with pharmacies and business partners to verify claims, address recoupments, and help ensure accurate billing and regulatory compliance. What you'll do... Respond to third‑party payer audit requests by researching claim and billing information, gathering prescription records, and preparing documentation. Review audit findings, support appeals, and track audit requests to ensure deadlines and compliance requirements are met. Analyze billing data and recoupments to identify trends, risks, and opportunities to improve processes. Collaborate with pharmacy teams, managers, and business partners to resolve billing issues and provide guidance on audit findings. Maintain HIPAA‑compliant documentation and ensure records meet federal and company requirements. This role reports to the Billing Manager. What You'll Bring… Knowledge of pharmacy billing processes or healthcare reimbursement environments. Experience using Excel to review, organize, and analyze audit data. Strong attention to detail when reviewing claims, records, and audit documentation. Ability to manage multiple audit requests and deadlines while maintaining accuracy. Clear communication skills when working with cross‑functional partners and pharmacy teams.
Requirements
- Knowledge of pharmacy billing processes or healthcare reimbursement environments.
- Experience using Excel to review, organize, and analyze audit data.
- Strong attention to detail when reviewing claims, records, and audit documentation.
- Ability to manage multiple audit requests and deadlines while maintaining accuracy.
- Clear communication skills when working with cross‑functional partners and pharmacy teams.
- Associate’s degree in Business Administration, Finance, Accounting, or related field OR 1 year’s experience in accounting, medical billing, medical coding, or related area.
Nice To Haves
- Experience working with pharmacy claims, third‑party payer audits, or billing compliance.
- Experience reviewing large datasets to identify trends, patterns, or discrepancies.
- Familiarity with AI tools or technologies that support data analysis or workflow efficiency such as ChatGPT, Dataiku, SQL, Python, Code Puppy.
- Experience improving operational workflows or identifying opportunities for process improvement.
Responsibilities
- Respond to third‑party payer audit requests by researching claim and billing information, gathering prescription records, and preparing documentation.
- Review audit findings, support appeals, and track audit requests to ensure deadlines and compliance requirements are met.
- Analyze billing data and recoupments to identify trends, risks, and opportunities to improve processes.
- Collaborate with pharmacy teams, managers, and business partners to resolve billing issues and provide guidance on audit findings.
- Maintain HIPAA‑compliant documentation and ensure records meet federal and company requirements.
Benefits
- At Walmart, we offer competitive pay as well as performance-based bonus awards and other great benefits for a happier mind, body, and wallet.
- Health benefits include medical, vision and dental coverage.
- Financial benefits include 401(k), stock purchase and company-paid life insurance.
- Paid time off benefits include PTO (including sick leave), parental leave, family care leave, bereavement, jury duty, and voting.
- Other benefits include short-term and long-term disability, company discounts, Military Leave Pay, adoption and surrogacy expense reimbursement, and more.
- You will also receive PTO and/or PPTO that can be used for vacation, sick leave, holidays, or other purposes.
- Live Better U is a Walmart-paid education benefit program for full-time and part-time associates in Walmart and Sam's Club facilities.
- Programs range from high school completion to bachelor's degrees, including English Language Learning and short-form certificates.
- Tuition, books, and fees are completely paid for by Walmart.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
Associate degree
