Specialist II, Billing- Bentonville, AR (Not Remote)
What you'll do...
This is NOT Remote job
The Health and Wellness Billing Team is looking for a task-oriented individual with an acute attention to details who excels at prioritization and collaboration. As a Billing Specialist II, you will respond to third-party pharmacy audit requests, research claim details, defend pharmacy recoupments and issue corrective actions and compliance guidance to pharmacy associates. Reporting to the Billing Manager, you will communicate potential concerns, risks and trends while applying critical thinking skills to identify potential operational or procedural solutions.
Who we are...
Pharmacy Audit and Billing team that responds to third-party payer audit requests, investigates and challenges findings, while capturing insights to drive actionable intelligence to mitigate risk and promote pharmacy compliance adherence.
What you'll do...
- Support Health & Wellness in responding to third party audit requests and investigations by verifying billing and claim details for third party payers; gathering data and prescription records; tracking audit requests; and ensuring accuracy of data, discrepancies, and recoupments.
- Complete work assignments and priorities in Health and Wellness Audit by using policies, data, and resources; collaborating with managers, coworkers, customers, pharmacies, and other business partners. Identify priorities, deadlines, and expectations; carry out tasks; communication of progress and information; determine and recommend improvement opportunities; and adapt to and learn from change, difficulties, and feedback.
- Identify and monitor past, present, and future risks in the audit of groups under review; translating audit findings; gathering proper appeal documentation; and ensuring audit request deadlines are met.
- Maintain and store HIPAA related records that must comply with Federal and Corporate requirements.
- Respond to third-party audit request by reviewing the request and pulling the requested documents. Organize the documents and send to the third party. Save all the documents in the assigned folder along with read receipts.
- Track the prescriptions that are requested from the third-party vendor in a checklist for each audit and enter the information in the Inmar Audit tool that is used to run reports.
- Review the results that will be sent back for each audit to determine if an appeal is needed. Then at that point put together the appeal document request and sent to store with a deadline to receive the documents. Once documents are received then review to ensure they are correct and submit to the third-party vendor.
- Review the finals that will be sent back from the appeal and enter the data in the Inmar Audit tool by tagging the prescriptions with the correct tags that relate to the discrepancies flagged by the third party.
- Share any findings and any other information that is important in team meeting and to your manager.
- Bachelor's degree in Business, Healthcare, Compliance, or 3 years' experience in healthcare, medical billing, audit, compliance, or pharmacy field.
- Moderate to advanced Excel skills
- Must be within 50 miles of Bentonville, AR office
You will sweep us off our feet if are...
- Subject matter expert in the Pharmacy space
- Driven to execute and act quickly.
- Process-minded and look for opportunities to streamline for improved efficiency and effectiveness.
- Strong communication skills to interact with leadership and stakeholders.
- Organized, disciplined, and can manage multiple projects simultaneously while achieving results.
Benefits & Perks:
Beyond competitive pay, you can receive incentive awards for your performance. Other great perks include 401(k) match, stock purchase plan, paid maternity and parental leave, PTO, multiple health plans, and much more.
Equal Opportunity Employer
Walmart, Inc. is an Equal Opportunity Employer - By Choice. We believe we are best equipped to help our associates, customers and the communities we serve live better when we really know them. That means understanding, respecting and valuing diversity- unique styles, experiences, identities, ideas and opinions - while being inclusive of all people.
Who We Are
Join Walmart and your work could help over 275 million global customers live better every week. Yes, we are the Fortune #1 company. But you'll quickly find we're a company who wants you to feel comfortable bringing your whole self to work. A career at Walmart is where the world's most complex challenges meet a kinder way of life. Our mission spreads far beyond the walls of our stores. Join us and you'll discover why we are a world leader in diversity and inclusion, sustainability, and community involvement. From day one, you'll be empowered and equipped to do the best work of your life
Outlined below are the required minimum qualifications for this position. If none are listed, there are no minimum qualifications.
Minimum Qualifications: Bachelor's degree in Business Administration, Computer Science, Finance, Accounting, or related field OR 2 years' experience in accounting, medical billing, medical coding, or related area.
Outlined below are the optional preferred qualifications for this position. If none are listed, there are no preferred qualifications.
2608 Se J St, BENTONVILLE, AR 72712, United States of America