Specialty Billing Technician

Walgreens•Wauwatosa, WI

About The Position

Responsible for accurate billing and collection of third-party and patient payments for products and services rendered. The role includes submitting and processing claims and payments, resolving billing issues, supporting prescription exceptions, and communicating with patients, providers, payers, and pharmacy staff. It also requires subject matter expertise in external billing practices and patient financial assistance programs.

Requirements

High school diploma or equivalent.
Pharmacy Technician license in states where required.
Maintain PTCB or ExCPT certification through the designated training program and/or state-required certification or registration.
Experience communicating verbally and in writing with varied audiences.
Experience providing customer service to internal and external customers, meeting service quality standards, and evaluating customer satisfaction.
Experience with processes related to submitting medical claims, including Medicare submission, EOBs, remittance advice, and timely filing limits.
Experience entering data into databases, such as MS Excel.

Nice To Haves

Six months of experience in a retail environment.
Prior work experience with Walgreens.

Responsibilities

Submit timely, accurate invoices to payers for products and services provided.
Determine correct quantities and prices for billed products and services.
Verify that products and services are authorized and required documentation is on file.
Ensure Medicare documentation is received from the medical provider and submitted to Danville.
Review reports to maximize generic substitution opportunities.
Manage and collect patient balances before prescription dispensing or in accordance with company policy.
Ensure billing documentation is complete and accurate before claim submission.
Process reimbursement checks and payments in accordance with policy.
Review price modify logs and confirm corresponding SDL claims are present.
Research and resolve third-party chargebacks in a timely manner.
Assist with third-party audits in accordance with company policy.
Process and file SDL claims in accordance with company policy.
Process prescription exceptions, including prior authorizations, referrals to other Walgreens locations, and identification of copay assistance opportunities.
Proactively communicate with patients and providers about referral and prescription status.
Assist patients with financial assistance program enrollment, confirm eligibility, and maintain required reporting and documentation.
Handle telephone calls that do not require a pharmacist's personal attention, including calls to physicians and third-party payers.
Maintain expertise in external billing practices, including third-party adjudications, prior authorization, and patient financial assistance programs, and coach pharmacy technicians and other support staff.