Specialty Billing Technician

Walgreens•New Brunswick, NJ

About The Position

Responsible for accurate billing and collection of third-party and patient payments for products and services rendered. The role submits and reviews claims, verifies authorizations and supporting documentation, processes payments, resolves chargebacks, assists with audits, and handles prescription exceptions and referrals. It also includes communicating with patients, providers, physicians, and third-party payers; helping patients enroll in financial assistance programs; and coaching pharmacy technicians and support staff on external billing practices. The position requires a high school diploma or equivalent and applicable pharmacy technician certification or registration. Preferred qualifications include six months of retail experience, prior Walgreens experience, and experience with medical claims, Medicare submissions, EOBs, remittance advice, timely filing limits, and database entry.

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 maintain state-required certification or registration.
Experience communicating verbally and in writing with varied audiences, including work groups, teams, management, prospective acquisitions, and external clients.
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 the correct quantities and prices for products and services billed.
Verify that services and products are properly 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 required billing documentation is complete and accurate before claim submission, including medical claims billing.
Process reimbursement checks and payments in accordance with policy.
Review price-modification logs and ensure corresponding SDL (submit direct link) 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 authorizations, and patient financial assistance programs, and coach pharmacy technicians and other support staff.