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Coordinator, Bill Processing Support - Cmi

Company: Walmart
Location: Rogers
Posted on: November 27, 2019

Job Description:

Resolves claim issues by evaluating adjuster claim notes; reviewing pharmacy drug use history to determine if requested prescription meets adjuster's authorization guidelines; reviewing provider complaints; analyzing the state fee schedule guidelines to identify billing errors; evaluating sources of errors (for example, processor, adjuster); forwarding complaints to appropriate people for correction; correcting and completing bills pended due to Electronic Data Interface (EDI) transmission errors; auditing and correcting inappropriately billed pharmacy charges; and recovering monies paid on inappropriately billed charges. Obtains bill processing information by researching data from multiple systems to obtain accurate communication for claims examiners, vendor processor coordinators, and reevaluation analysts; researching data discrepancies using the claims system, imaging system, and bill review system; updating the pharmacy online system with the correct information discovered through research; investigating incoming faxes and e-mails for proper handling and referral; researching and correcting errors on electronic bills falling into the pharmacy bill exception queue; and auditing prescription drug reversal reports to determine recovery amounts of previously paid prescriptions. Maintains customer service and communication by resolving billing concerns for stores, adjusters, and medical providers; initiating calls for additional information; ensuring providers and claims examiners receive answers to bill re-pricing and status of payment questions; and responding with urgency to requests for assistance from Walmart Pharmacy associates to obtain manual approval or denial of prescriptions for injured associates. Provides administrative support by running reports for adjusters regarding prescription usage of claimants; mail merging reports and sending communication on behalf of adjusters to treating physicians regarding utilization of prescription drugs outside of normal limits; maintaining pharmacy electronic exception queue currency; distributing faxes to Bill Processing team from team fax server; activating or deactivating prescription eligibility in the electronic pharmacy system; and working pharmacy prescription reversal reports to recover monies paid on inappropriately billed prescriptions.Minimum Qualifications...Outlined below are the required minimum qualifications for this position. If none are listed, there are no minimum qualifications. Preferred Qualifications...Outlined below are the optional preferred qualifications for this position. If none are listed, there are no preferred qualifications. Customer Service, Healthcare Strategy, Insurance, Legal, Walmart

Keywords: Walmart, Rogers , Coordinator, Bill Processing Support - Cmi, Other , Rogers, Arkansas

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