Senior Specialist, HAR Provider Enrollment

Walgreens; Danville (IL); On-site; USD 21,000 - 41,000; Full time

Job summary

Walgreens is seeking a Senior Specialist, HAR Provider Enrollment to manage provider enrollment processes, ensure compliance, and maintain strong client relationships. You will handle initial and renewal applications for billing at federal, state, and commercial levels, and support pharmacy operations with timely, accurate processing.

Responsibilities include state Medicaid enrollment, demographic updates, escalation handling, and collaboration across teams to improve enrollment workflows while

Qualifications

• High School Diploma or GED plus at least 1 year in an office or customer service.
• Proficient in MS Windows and basic PC skills.
• Experience with Microsoft Word, Excel, and Access.
• Experience providing customer service to internal and external customers.
• Excellent verbal and written communications.

Responsibilities

• Processes, either on paper or online, all pharmacy enrollment applications accurately, completely, and timely to support pharmacy operations.
• Serve as a subject matter expert related to the enrollments of their assigned state Medicaids.
• Research applicable enrollment or participation rules and regulations within each state funded programs, not limited to Medicaids, for changes.
• Maintain current pharmacy demographic, ownership, and managing employee/officer information on file with NCPDP, NPPES, and the various state and governmental payers and DMEPOS Accreditation vendor.
• Processes, either on paper or online, all SNAP and WIC enrollment applications accurately, completely, and timely to support operations.
• Serves as first escalation point for enrollment problem resolution.
• Investigate, troubleshoot, and solve operational issues as it relates to being a recognized billing provider.
• Applies Walgreens policies in the security of personal information and the internal Legal guidance for credentialing responses.
• Obtains and maintains governmental portal web access for enrollments, prior auths, claim status, and remittance detail for pharmacy personnel and HAR team members.
• Coordinates with other functional and operational areas as necessary
• Contacts state Medicaid offices or processors for clarification or issue resolution
• Cultivates an innovation mindset to improve processes within regulatory framework
• Assist in training and mentoring new Provider Enrollment Coordinators
• Plans, prioritizes, organizes and completes work to meet objectives/SLAs/Timelines
• Monitors trends and notifies supervisor of recurring or high priority issues.

Skills

Customer service

Communication

Data entry

Attention to detail

Education

High School Diploma or GED

Bachelor's degree

Tools

Microsoft Word

Microsoft Excel

Microsoft Access

Job description

Job Summary

As a Senior Specialist, HAR Provider Enrollment, you will be responsible for Provider Enrollment process management, compliance management, and client/customer relationship management. You will be expected to adhere to federal and state regulations regarding the initial application for and the renewal of the provider status to service and bill at all of the Walgreen pharmacies. You will process accurately, completely, and timely all initial applications or renewal applications required for the billing of pharmacy products and services at the commercial, state, and federal level and also ensure all contacts receive efficient and courteous service.

Job Responsibilities

• Processes, either on paper or online, all pharmacy enrollment applications accurately, completely, and timely to support pharmacy operations. Serve as a subject matter expert related to the enrollments of their assigned state Medicaids.
• Research applicable enrollment or participation rules and regulations within each state funded programs, not limited to Medicaids, for changes.
• Maintain current pharmacy demographic, ownership, and managing employee/officer information on file with NCPDP, NPPES, and the various state and governmental payers and DMEPOS Accreditation vendor
• Processes, either on paper or online, all SNAP and WIC enrollment applications accurately, completely, and timely to support operations
• Serves as first escalation point for enrollment problem resolution. Anticipates the needs of the customer, takes ownership of the issue and proactively identifies solutions. Seeks guidance from supervisory or managerial staff only for the most complex or critical escalated questions or problems.
• Investigate, troubleshoot, and solve operational issues as it relates to being a recognized billing provider.
• Apply WAG policies in the security of the personal information and the internal Legal guidance for the credentialing responses.
• Obtains and maintains governmental portal web access for enrollments, prior auths, claim status, and remittance detail for pharmacy personnel and HAR team members
• Coordinates with other functional and operational areas as necessary
• Contacts state Medicaid offices or processors, as needed, for clarification or issue resolution
• Cultivates an innovation mindset, looks for ways to improve current processes with enhancements and ideas, working within the regulatory framework.
• Assist in training process and mentoring new Provider Enrollment Coordinators and assumes a mentorship role.
• Plans, prioritizes, organizes and completes work to meet established objectives/SLAs/Timelines.
• Monitors trends and notifies supervisor of recurring or high priority issues.

About Walgreens

Founded in 1901, Walgreens (www.walgreens.com) proudly serves nearly 9 million customers and patients each day across its approximately 8,500 stores throughout the U.S. and Puerto Rico. Walgreens has approximately 220,000 team members, including nearly 90,000 healthcare service providers, and is committed to being the first choice for pharmacy, retail and health services, building trusted relationships that create healthier futures for customers, patients, team members and communities.

Basic Qualifications

• High School Diploma or GED plus at least 1 years’ experience in an office or customer service position.
• Intermediate level keyboarding skills and basic level PC skills (at least 25 WPM, touch typing, formatting documents, using mouse, know how to navigate MS Windows, know how to print and do searches).
• Basic level skill in Microsoft Office: Word (for example: creating documents, entering and formatting text, page layouts, creating tables, and adding graphics) and Excel (for example: creating worksheets, entering data, creating basic formulas, working with cells and rows) and Access.
• Experience providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction.
• Experience with professional communications. Both verbally (on the phone, one-on-one) and in writing (emails, letters) to various audiences (work group, team, company management, external agencies)

Preferred Qualifications

• Bachelors degree
• Experience with applicable U.S. Healthcare regulations.
• At least 2 years of experience working in an office.
• Intermediate level skill in Microsoft Access (for example: opening a table in datasheet view, entering data, filtering data, creating a form, modifying a form layout, applying themes, running, sorting and saving queries, creating and formatting a report, changing report test, adding an image, printing labels, navigating through records, and/or exporting to Excel).
• Experience with analyzing and reporting data in order to identify issues, trends, or exceptions to drive improvement of results and find solutions.
• Experience providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction.
• Experience reviewing and auditing own work or others' work.

We will consider employment of qualified applicants with arrest and conviction records. The Salary below is being provided to promote pay transparency and equal employment opportunities at Walgreens. The actual hourly salary within this range that you will be offered will depend on a variety of factors including geography, skills and abilities, education, experience and other relevant factors. This role will remain open until filled.

Salary Range: $15 - $30.29 / Hourly