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Job Details


Walgreens

Spec 3rd Party Rx Ops Pharmacy Tech Services

Retail

All

Yearly

No

Deerfield, Illinois, United States

Job Summary

Responsible for the update, maintenance, auditing, and operation of third party prescription plans including Commercial, Government, 340B and Walgreens Direct Bill contracts. Enters plans into pharmacy system and provides issue resolution and support for the stores. Investigates Payer Inquiry Tickets from Payor Partners, Enterprise Prescriber Data File issue resolution and Audits, Prescriber and prescriptive authority tickets, proper processing of prescription claims including order of claims processing for government payers. Ensures claims meet National Council for Prescription Drug Programs (NCPDP) HIPAA compliant standard and values supported, creates Job Aids and field communications.


Job Responsibilities

  • Responsible for the update, maintenance, auditing, and operation of third party prescription plan contracts, including entering plans into pharmacy system and reviewing all information to meet current NCPDP HIPAA standard.
  • Responsible for resolving problems and questions regarding third party prescription plans from stores, claims processors, Walgreens Direct Bill contracts and other applicable parties. Identifies and recommends best practices solutions to recurring issues.
  • Enters plan specifications into the appropriate systems using payer sheets, ensuring compliance with plan provisions, Walgreens Direct Bill contracts, coordination of benefits, corporate guidelines, and Federal, state, and/or local regulations.
  • Develops test data for NCPDP compliance to the current HIPAA standard and conducts on-line tests to ensure appropriate claims processing and reimbursement. Identifies and implements corrective actions for test results that are not compliant with the plan specifications.
  • Collaborates with third party payor and Walgreens Direct Bill contracts and appropriate Walgreens team members to ensure operational performance and compliance with the responsible third party contractor.
  • Analyzes and recommends corrective actions to system discrepancies, prescription and reimbursement data, vendor changes, claims processors, etc. Experience with query databases to pull claims data.
  • Maintains up-to-date knowledge about State Medicaid agencies by monitoring and reporting on bulletins and updates to claims processing and assigned web portals.
  • Responsible for the update, maintenance, auditing, and operation of prescriber information,including updating and entering prescriber information into the pharmacy system and investigating any necessary information.
  • Responsible for resolving questions regarding prescriber information from stores, processors, and other applicable parties. Identifies and recommends best practices.
  • Utilizes skills in Excel, PowerPoint and the ability to query databases in order to assist analysts in the creation of presentations and training for store staff and supervision.
  • Assists other Walgreens departments with audits, both fiscal and operational, to ensure all appropriate data is made available to accurately complete internal and external plan audits.
  • May respond to federal and state issued subpoenas and coordinate access to internal corporate applications. May also perform various administrative functions, when necessary, such as scheduling meetings, coordinating group events etc).
  • Acts as a liaison and partners with Provider Enrollment, Accounting, Contracting, Medicare B Operations, and Third Party Audit teams for store team members and field leadership support.

Basic Qualifications
  • High School Diploma/GED and at least 1 year of experience in retail pharmacy, medical claims processing, and/or third party reimbursement.
  • Required certification in Certified Pharmacy Technician as granted by PTCB.
  • Experience providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction.
  • Experience using time management skills such as prioritizing/organizing and tracking details and meeting deadlines of multiple projects with varying completion dates.
  • Experience providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of plan satisfaction.
  • Basic level skill in Microsoft Office - Word (for example: creating documents, entering and formatting text, page layouts, creating tables, and adding graphics), Excel (for example: creating worksheets, entering data, creating basic formulas, working with cells and rows) and PowerPoint (for example: creating a new presentation from a design template, adding and removing slides, entering and formatting text, adding speaker notes, and viewing presentations).

Preferred Qualifications
  • At least 2 years experience in pharmacy claims processing.