Specialist RCM - Quality Validation MM

Walgreens • Deerfield, IL

25d

About The Position

Responsible for validating patient orders, performing quality assurance with items to be shipped, monitors pre-shipment procedures and coordinates distribution review. Assists with meeting Revenue Cycle Management goal targets by understanding the verification process, the logistics process and working with J-Codes, diagnosis codes, route of administration, place of service, IPA claims, Medicare B & D billing, Major Medical and PBM. Walgreens Founded in 1901, Walgreens (www.walgreens.com) proudly serves nearly 9 million customers and patients each day across its approximately 8,500 stores throughout the U.S. and Puerto Rico. Walgreens has approximately 220,000 team members, including nearly 90,000 healthcare service providers, and is committed to being the first choice for pharmacy, retail and health services, building trusted relationships that create healthier futures for customers, patients, team members and communities.

Requirements

• High school diploma from accredited school or equivalent GED
• At least 2 years' work experience in pharmacy benefit or medical benefit insurance billing, and/or providing customer service to team members and external customers, including meeting quality standards for services, and evaluation of customer satisfaction.
• Good verbal and written communication and interpersonal skills with the ability to communicate in a diplomatic and confidential manner
• Strong initiative with the ability to work in a team environment
• Organized and detail oriented with proven problem solving skills.

Nice To Haves

• Associate's Degree in healthcare, business, or related area of study
• Relevant work experience in a Specialty Pharmacy, PBM and Major Medical

Responsibilities

• Utilizes all available resources to review and verify pre-shipment information for ordered items; verifies patient insurance coverage and completes a full Medical Verification of medications, administration supplies, and related pharmacy services through proper investigation into either major medical benefits or pharmacy benefits.
• Investigates prior authorization and any other claim rejections.
• Audits Major Medical claims for accuracy and document findings for quality improvement initiatives.
• Acts as subject matter expert in completing a full Medical Verification for all medications, administration of supplies and related pharmacy services and pre-shipment procedures.
• Communicates with other departments and senior managers as necessary to facilitate urgent needs.
• Enhanced review of high-risk referrals.
• Review patient A/R prior to completing referral audit.
• Other responsibilities as judgment or necessity dictate

Benefits

• To review benefits, please click here jobs.walgreens.com/benefits. If you are applying on a job board or unable to click on the link, please copy and paste this URL into your browser jobs.walgreens.com/bene

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED