Pharmacy Billing & Claims Specialist

Walgreens; Peoria (IL); On-site; USD 28,000 - 36,000; Full time

Job summary

Walgreens is seeking a Pharmacy Billing Specialist to handle accurate billing and collection of third-party and patient payments for products and services rendered. You will submit invoices, verify quantities and prices, and ensure proper documentation and authorizations are in place.

You will also manage patient balances, review Medicare documentation, assist with third-party audits, and support patients with financial assistance programs.

Qualifications

• High School Diploma or equivalent.
• Pharmacy Technician license where required.
• PTCB or ExCPT certification through training program and/or state required certification/registration.
• Experience communicating verbally and in writing to various audiences.

Responsibilities

• Submit timely, accurate invoices to payer for products and services provided.
• Correctly determine quantities and prices for products and services billed.
• Verify 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 prior to prescription dispensing, or per policy.
• Ensure all billing documentation is complete and accurate prior to claim submission.
• Process reimbursement checks/payments per policy.
• Review price modify logs and ensure SDL claims are present.
• Review, research and resolve all third party chargebacks in a timely manner.
• Assist with third party audits per policy.
• Process and file all SDL claims per policy.
• Handle prescription exceptions including prior authorizations and referrals to other Walgreens locations.
• Communicate with patients/providers regarding referral/prescription status.
• Assist patients with enrollment in assistance programs and verify eligibility.
• Handle non-personal calls to physicians and payers as needed.
• Coach staff on external billing practices to support billing accuracy.

Skills

Billing

Customer service

Communication

Attention to detail

Medicare knowledge

Education

High School Diploma or GED

Pharmacy Technician license

PTCB or ExCPT certification ongoing

Tools

MS Excel

Job description

Walgreens is seeking a Pharmacy Billing Specialist to handle accurate billing and collection of third-party and patient payments for products and services rendered. You will submit invoices, verify quantities and prices, and ensure proper documentation and authorizations are in place.

You will also manage patient balances, review Medicare documentation, assist with third-party audits, and support patients with financial assistance programs.