Specialist RCM-Quality Validation, Major Medical (Remote)
3.
4 Deerfield, IL Deerfield, IL $15 - $20 an hour $15 - $20 an hour Job
Summary:
Responsible for validating patient orders, performing quality assurance with items to be shipped, monitors pre-shipment procedures and coordinates distribution review.
Assists with meeting Revenue Cycle Management goal targets by understanding the verification process, the logistics process and working with J-Codes, diagnosis codes, route of administration, place of service, IPA claims, Medicare B & D billing, Major Medical and PBM.
Job
Responsibilities:
Utilizes all available resources to review and verify pre-shipment information for ordered items; verifies patient insurance coverage and completes a full Medical Verification of medications, administration supplies, and related pharmacy services through proper investigation into either major medical benefits or pharmacy benefits.
Investigates prior authorization and any other claim rejections.
Audits Major Medical claims for accuracy and document findings for quality improvement initiatives.
Acts as subject matter expert in completing a full Medical Verification for all medications, administration of supplies and related pharmacy services and pre-shipment procedures.
Communicates with other departments and senior managers as necessary to facilitate urgent needs.
Other responsibilities as judgment or necessity dictate About Walgreens and WBA'' Walgreens (www.
walgreens.
com) is included in the U.
S.
Retail Pharmacy and U.
S.
Healthcare segments of Walgreens Boots Alliance, Inc.
(Nasdaq:
WBA), an integrated healthcare, pharmacy and retail leader with a 170-year heritage of caring for communities.
WBA's purpose is to create more joyful lives through better health.
Operating nearly 9,000 retail locations across America, Puerto Rico and the U.
S.
Virgin Islands, Walgreens is proud to be a neighborhood health destination serving nearly 10 million customers each day.
Walgreens pharmacists play a critical role in the U.
S.
healthcare system by providing a wide range of pharmacy and healthcare services, including those that drive equitable access to care for the nation's medically underserved populations.
To best meet the needs of customers and patients, Walgreens offers a true omnichannel experience, with fully integrated physical and digital platforms supported by the latest technology to deliver high-quality products and services in communities nationwide.
The actual salary an employee can expect to receive, plus bonus pursuant to the terms of any bonus plan if applicable, will depend on experience, seniority, geographic location, and other factors permitted by law.
To review benefits, please visit jobs.
walgreens.
com/benefits.
An Equal Opportunity Employer, including disability/veterans.
Basic Qualifications High school diploma from accredited school or equivalent GED 2 years' work experience in pharmacy benefit or medical benefit insurance billing, and/or providing customer service to team members and external customers, including meeting quality standards for services, and evaluation of customer satisfaction.
Good verbal and written communication and interpersonal skills with the ability to communicate in a diplomatic and confidential manner Strong initiative with the ability to work in a team environment Organized and detail oriented with proven problem solving skill Preferred Qualifications Associate's Degree in healthcare, business, or related area of study Relevant work experience in a Specialty Pharmacy, PBM and Major Medical #LI-AJ1.
Estimated Salary: $20 to $28 per hour based on qualifications.
4 Deerfield, IL Deerfield, IL $15 - $20 an hour $15 - $20 an hour Job
Summary:
Responsible for validating patient orders, performing quality assurance with items to be shipped, monitors pre-shipment procedures and coordinates distribution review.
Assists with meeting Revenue Cycle Management goal targets by understanding the verification process, the logistics process and working with J-Codes, diagnosis codes, route of administration, place of service, IPA claims, Medicare B & D billing, Major Medical and PBM.
Job
Responsibilities:
Utilizes all available resources to review and verify pre-shipment information for ordered items; verifies patient insurance coverage and completes a full Medical Verification of medications, administration supplies, and related pharmacy services through proper investigation into either major medical benefits or pharmacy benefits.
Investigates prior authorization and any other claim rejections.
Audits Major Medical claims for accuracy and document findings for quality improvement initiatives.
Acts as subject matter expert in completing a full Medical Verification for all medications, administration of supplies and related pharmacy services and pre-shipment procedures.
Communicates with other departments and senior managers as necessary to facilitate urgent needs.
Other responsibilities as judgment or necessity dictate About Walgreens and WBA'' Walgreens (www.
walgreens.
com) is included in the U.
S.
Retail Pharmacy and U.
S.
Healthcare segments of Walgreens Boots Alliance, Inc.
(Nasdaq:
WBA), an integrated healthcare, pharmacy and retail leader with a 170-year heritage of caring for communities.
WBA's purpose is to create more joyful lives through better health.
Operating nearly 9,000 retail locations across America, Puerto Rico and the U.
S.
Virgin Islands, Walgreens is proud to be a neighborhood health destination serving nearly 10 million customers each day.
Walgreens pharmacists play a critical role in the U.
S.
healthcare system by providing a wide range of pharmacy and healthcare services, including those that drive equitable access to care for the nation's medically underserved populations.
To best meet the needs of customers and patients, Walgreens offers a true omnichannel experience, with fully integrated physical and digital platforms supported by the latest technology to deliver high-quality products and services in communities nationwide.
The actual salary an employee can expect to receive, plus bonus pursuant to the terms of any bonus plan if applicable, will depend on experience, seniority, geographic location, and other factors permitted by law.
To review benefits, please visit jobs.
walgreens.
com/benefits.
An Equal Opportunity Employer, including disability/veterans.
Basic Qualifications High school diploma from accredited school or equivalent GED 2 years' work experience in pharmacy benefit or medical benefit insurance billing, and/or providing customer service to team members and external customers, including meeting quality standards for services, and evaluation of customer satisfaction.
Good verbal and written communication and interpersonal skills with the ability to communicate in a diplomatic and confidential manner Strong initiative with the ability to work in a team environment Organized and detail oriented with proven problem solving skill Preferred Qualifications Associate's Degree in healthcare, business, or related area of study Relevant work experience in a Specialty Pharmacy, PBM and Major Medical #LI-AJ1.
Estimated Salary: $20 to $28 per hour based on qualifications.
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