Specialty Billing Technician

Walgreens; Durham (NC); On-site; USD 25,000 - 33,000; Full time

Job summary

Walgreens is seeking a Pharmacy Billing Specialist in Durham, NC to manage accurate billing and collection for third party and patient payments. Responsibilities include invoicing payers, ensuring proper documentation, handling prior authorizations, and assisting with audits and patient copay programs.

The role requires a Pharmacy Technician license where required, PTCB/ExCPT certification, and strong communication and customer service skills. Prior Walgreens experience is a plus.

Qualifications

• High School Diploma or equivalent required.
• Pharmacy Technician license in states where required; may require certification.
• PTCB or ExCPT certification through approved program or state registration.
• Experience communicating with various audiences (phone, email, reports).
• Experience providing customer service to internal and external customers.

Responsibilities

• Submit timely invoices to payer for products and services.
• Determine quantities and prices billed accurately.
• Verify authorizations and required documentation.
• Ensure Medicare documentation is received and submitted.
• Review reports to maximize substitution opportunities.
• Manage and collect patient balances prior to dispensing.
• Ensure billing documentation is complete before claim submission.
• Process reimbursement checks per policy.
• Review price modify logs for SDL claims.
• Resolve third party chargebacks promptly.
• Assist with third party audits per policy.
• Process and file SDL claims as required.
• Handle prescription exceptions including prior authorizations and referrals.

Skills

Verbal communication

Written communication

Customer service

Education

High School Diploma or equivalent

Pharmacy Technician license

PTCB or ExCPT certification

Tools

MS Excel

Job description

Responsible for the accurate billing and collection of third party and patient payments for products and services rendered.

Job Responsibilities (listed in order of importance and/or time spent)

• 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.

Basic 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, 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.

Preferred Qualifications

• Prefer six months of experience in a retail environment.
• Prefer to have prior work experience with Walgreens.
• Experience in processes related to submitting medical claims, including but not limited to Medicare submission, knowledgeable in EOB (explanation of benefits), remittance advice and adherence to timely filing limits.
• Experience entering data into databases (e.g., MS Excel).

We will consider employment of qualified applicants with arrest and conviction records.

An Equal Opportunity Employer, including disability/veterans.

Salary Range: $18 - $24.25 / Hourly