Reimbursement Specialist II Pharmacy
Walgreens - Columbia, MO

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Job Duties Include: Acts as a lead, coordinating the work of Reimbursement Specialists. Resolves more complex inquiries and/or complaints escalated by the Reimbursement Specialists. Performs all duties of the Reimbursement Specialist job. Acts as a resource for colleagues; may direct the work of other staff members. May assist in training of new team members and may provide input to the employees’ performance evaluations. Acts as Subject Matter Expert and works autonomously to handle more complex issues related to the collections, within established procedures and practices.

Submits timely, accurate invoices to payer for products and services provided. Understands the terms and fee schedule for all contracts for which invoices are submitted. Correctly determines quantities and prices for drugs billed. Verifies that the services and products are correctly authorized and that required documentation is on file. Ensures that invoices are submitted for services and products that are properly ordered and confirmed as provided. Evaluates payments received for correctness and applies payments accurately to the system. Verifies that payments received are correct according to the fee schedule. Applies the payment correctly to the patient account. Ensures that secondary bills and patient invoices are mailed within 48 hours of receipt of payment. Notifies the Reimbursement Manager if there are overpayments and/or duplicate payments for the same service. Transfers payments belonging to other offices within 48 hours of receipt.

Follows up on invoices submitted to ensure prompt and timely payment. Calls to verify that claims submitted were received and are in processing. Sends letters to the patient or responsible party when their insurance carrier fails to make payment reasonable time frame. Generates and mails statements and collections letters per Walgreens policy. Follows-up on all denials within 48 hours of receipt.

Minimum Requirements:
  • High School Diploma or equivalent and at least 1 year of healthcare intake/admissions and/or reimbursement experience.

  • Experience in identifying operational issues and recommending and implementing strategies to resolve problems.

  • Intermediate level skill in Microsoft Excel (for example: using SUM function, setting borders, setting column width, inserting charts, using text wrap, sorting, setting headers and footers and/or print scaling).

  • Basic level skill in Microsoft Word (for example: opening a document, cutting, pasting and aligning text, selecting font type and size, changing margins and column width, sorting, inserting bullets, pictures and dates, using find and replace, undo, spell check, track changes, review pane and/or print functions).

Preferred Qualifications:
  • Previous Infusion Reimbursement or Intake/Admissions experience.

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