Specialty Billing Technician

Walgreens•Durham, NC

About The Position

Responsible for accurate billing and collection of third-party and patient payments for products and services rendered. The role submits and processes claims and invoices, verifies authorization and documentation, manages patient balances, resolves billing issues, and supports prescription exceptions and patient assistance programs. It also provides billing expertise and coaching to pharmacy technicians and other support staff.

Requirements

High school diploma or equivalent.
Pharmacy Technician license in states where required.
Maintain PTCB or ExCPT certification through the designated PTCB or ExCPT 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 for submitting medical claims, including Medicare submission; knowledge of 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 is preferred.
Prior work experience with Walgreens is preferred.

Responsibilities

Submit timely, accurate invoices to payers for products and services provided.
Determine correct quantities and prices for billed products and services.
Verify that services and products are correctly 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, including medical claims.
Process reimbursement checks and payments in accordance with policy.
Review price modify logs and confirm corresponding SDL (submit direct link) claims are present.
Review, 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.
Communicate proactively with patients and providers about referral and prescription status.
Maintain knowledge of patient assistance programs and help patients enroll, confirm eligibility, and complete 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.