Pharmacy Billing & Claims Specialist

Walgreens; Salt Lake City (UT); On-site; USD 30,000 - 40,000; Full time

Job summary

Walgreens is seeking a Billing Specialist responsible for accurate billing and collection of third-party and patient payments for products and services rendered. You will submit invoices, verify authorizations, and manage payer communications to ensure timely reimbursement.

The role requires strong data entry, attention to detail, and knowledge of Medicare documentation and EOBs. Prior pharmacy billing experience is preferred, with excellent customer service and communication skills.

Qualifications

• High School Diploma or equivalent.
• Pharmacy Technician license, in states where required.
• Maintains PTCB or ExCPT certification through the designated PTCB or ExCPT training program and/or state required certification/registration.
• Experience communicating both verbally (on phone, one-on-one, and to groups) and in writing (emails, letters, reports, presentations) to various audiences (work group, team, company management, prospective acquisitions, external clients).
• Experience providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction.

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 all 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 in accordance with company policy.
• Ensure all required documentation for billing is completed and accurate prior to claim submission (i.e., medical claims billing).
• Process reimbursement checks/payment in accordance with policy.
• Review price modify logs and ensure there are corresponding SDL (submit direct link) claims.
• Review, research and resolve all third party chargebacks in a timely manner.
• Assist with any third party audits, in accordance with company policy.
• Process and file all SDL (submit direct link) claims in accordance with company policy.
• Processing of prescription exceptions including prior authorizations, triaging of referrals to other Walgreens locations, and proactively identifying copay assistance opportunities.
• Responsible for proactive communication to patients and providers regarding referral/prescription status.
• Responsible for maintaining a deep understanding of and assisting patients with assistance programs enrollment, such as Chronic Disease Fund, confirming patient eligibility and all required reporting and documentation.
• Handles telephone calls that do not require personal attention of the pharmacist, including those to physicians and third party payers.
• Maintains subject matter expertise pertaining to all external billing practices including but not limited to third party adjudications, prior authorization, and patient financial assistance programs in order to coach pharmacy technicians and other support staff.

Skills

Verbal communication

Written communication

Customer service

Education

High School Diploma or equivalent

Pharmacy Technician license

PTCB or ExCPT certification

Job description

Walgreens is seeking a Billing Specialist responsible for accurate billing and collection of third-party and patient payments for products and services rendered. You will submit invoices, verify authorizations, and manage payer communications to ensure timely reimbursement.

The role requires strong data entry, attention to detail, and knowledge of Medicare documentation and EOBs. Prior pharmacy billing experience is preferred, with excellent customer service and communication skills.