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.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".