Specialty Pharmacy Billing Specialist

Walgreens; Worcester (MA); On-site; USD 30,000 - 40,000; Full time

Job summary

Walgreens in Worcester, MA is hiring for a Pharmacy Billing/Support role. The incumbent will submit and verify billing for products and services, ensure proper authorization and documentation, and manage Medicare submissions and third-party processes.

Ideal candidates hold a Pharmacy Technician license with PTCB/ExCPT certification and have strong communication and customer service skills, including Excel data entry and eligibility checks for patient assistance programs.

Qualifications

• High School Diploma or equivalent.
• Pharmacy Technician license, in states where required.
• Maintains PTCB or ExCPT certification through the designated training program and/or state required certification/registration.
• Experience communicating both verbally and in writing to various audiences.
• Experience providing customer service to internal and external customers, including meeting quality standards for services.

Responsibilities

• Submit timely, accurate invoices to payer for products and services provided.
• 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 and submitted.
• Review reports to maximize generic substitution opportunities.
• Manage and collect patient balances prior to prescription dispensing or per policy.
• Ensure all billing documentation for claims submission is complete and accurate.
• Process reimbursement checks/payments per policy.
• Review price modify logs and ensure SDL claims exist.
• Review, research and resolve third party chargebacks timely.
• Assist with third party audits per policy.
• Process and file all SDL claims per policy.
• Handle prescription exceptions including prior authorizations and triage referrals to other Walgreens locations.
• Communicate proactively with patients and providers regarding referral/prescription status.
• Assist patients with enrollment in assistance programs (e.g., Chronic Disease Fund) and verify eligibility and reporting.
• Handle calls not requiring pharmacist attention (to physicians and third party payers).
• Maintain expertise on external billing practices to coach staff.

Skills

Communication skills

Customer service

MS Excel

Education

High School Diploma or equivalent

Pharmacy Technician license

PTCB/ExCPT certification

Tools

MS Excel

Job description

Walgreens in Worcester, MA is hiring for a Pharmacy Billing/Support role. The incumbent will submit and verify billing for products and services, ensure proper authorization and documentation, and manage Medicare submissions and third-party processes.

Ideal candidates hold a Pharmacy Technician license with PTCB/ExCPT certification and have strong communication and customer service skills, including Excel data entry and eligibility checks for patient assistance programs.