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Specialist 3rd Party Rx Operations Pharmacy Technician Services
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Deerfield, IL Deerfield, Illinois |
About this job
Job Summary
Responsible for the update, maintenance, auditing, and operation of third party prescription plan contracts, including entering plans into the system, investigating all missing information, and issues resolution from the stores.
Job Responsibilities
* Responsible for the update, maintenance, auditing, and operation of third party prescription plan contracts, including entering plans into the system and investigating all missing information.
* Responsible for resolving problems and questions regarding third party prescription plans from stores, claims processors, and other applicable parties. Identifies and recommends best practices solutions to recurring issues.
* Enters plan specifications into the appropriate systems, ensuring compliance with plan provisions, corporate guidelines, and Federal, state, and/or local regulations.
* Develops and test data for each new plan 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 appropriate Walgreens team members to ensure operational performance and compliance with the responsible third party contractor.
* Analyzes and recommends corrective actions to systems discrepancies, prescription and reimbursement data, vendor changes, claims processors, etc.
* 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).
Walgreens, one of the nation's largest drugstore chains, is included in the Retail Pharmacy USA Division of Walgreens Boots Alliance, Inc., the first global pharmacy-led, health and wellbeing enterprise. More than 10 million customers interact with Walgreens each day in communities across America, using the most convenient, multichannel access to consumer goods and services and trusted, cost-effective pharmacy, health and wellness services and advice. Walgreens operates 8,175 drugstores with a presence in all 50 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands. Walgreens omnichannel business includes Walgreens.com. Approximately 400 Walgreens stores offer Healthcare Clinic or other provider retail clinic services.
As the neighborhood drugstore and retailer, our goal is to make health and happiness simpler, easier and within reach. And we remain a trusted wellness provider offering convenient access to important health services, such as immunizations and an array of pharmacy services that can help patients improve their health. To our team members, Walgreens represents a unique opportunity to excel in their careers in a welcoming and inclusive environment. We offer the chance to work in a truly supportive environment, and be a part of a progressive organization dedicated to the well-being of our customers, team members and the communities we all call home.
Basic Qualifications
* High School Diploma/GED and at least 2 years of experience in retail pharmacy, medical claims processing, and/or third party reimbursement.
* Required certification in Certified Pharmacy Technician as granted by PTCB.
* Experience providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction.
* Experience with project management (for example: planning, organizing, and managing resources to bring about the successful completion of specific project goals and objectives).
* Basic level skill in Microsoft Office 2003 or later: Word (for example: creating documents, entering and formatting text, page layouts, creating tables, and adding graphics), Excel (for example: creating worksheets, entering data, creating basic formulas, working with cells and rows) and PowerPoint (for example: creating a new presentation from a design template, adding and removing slides, entering and formatting text, adding speaker notes, and viewing presentations).
Preferred Qualifications
* At least 2 years of experience in pharmacy claims processing.
Apply Save jobSaved
Responsible for the update, maintenance, auditing, and operation of third party prescription plan contracts, including entering plans into the system, investigating all missing information, and issues resolution from the stores.
Job Responsibilities
* Responsible for the update, maintenance, auditing, and operation of third party prescription plan contracts, including entering plans into the system and investigating all missing information.
* Responsible for resolving problems and questions regarding third party prescription plans from stores, claims processors, and other applicable parties. Identifies and recommends best practices solutions to recurring issues.
* Enters plan specifications into the appropriate systems, ensuring compliance with plan provisions, corporate guidelines, and Federal, state, and/or local regulations.
* Develops and test data for each new plan 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 appropriate Walgreens team members to ensure operational performance and compliance with the responsible third party contractor.
* Analyzes and recommends corrective actions to systems discrepancies, prescription and reimbursement data, vendor changes, claims processors, etc.
* 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).
Walgreens, one of the nation's largest drugstore chains, is included in the Retail Pharmacy USA Division of Walgreens Boots Alliance, Inc., the first global pharmacy-led, health and wellbeing enterprise. More than 10 million customers interact with Walgreens each day in communities across America, using the most convenient, multichannel access to consumer goods and services and trusted, cost-effective pharmacy, health and wellness services and advice. Walgreens operates 8,175 drugstores with a presence in all 50 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands. Walgreens omnichannel business includes Walgreens.com. Approximately 400 Walgreens stores offer Healthcare Clinic or other provider retail clinic services.
As the neighborhood drugstore and retailer, our goal is to make health and happiness simpler, easier and within reach. And we remain a trusted wellness provider offering convenient access to important health services, such as immunizations and an array of pharmacy services that can help patients improve their health. To our team members, Walgreens represents a unique opportunity to excel in their careers in a welcoming and inclusive environment. We offer the chance to work in a truly supportive environment, and be a part of a progressive organization dedicated to the well-being of our customers, team members and the communities we all call home.
Basic Qualifications
* High School Diploma/GED and at least 2 years of experience in retail pharmacy, medical claims processing, and/or third party reimbursement.
* Required certification in Certified Pharmacy Technician as granted by PTCB.
* Experience providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction.
* Experience with project management (for example: planning, organizing, and managing resources to bring about the successful completion of specific project goals and objectives).
* Basic level skill in Microsoft Office 2003 or later: Word (for example: creating documents, entering and formatting text, page layouts, creating tables, and adding graphics), Excel (for example: creating worksheets, entering data, creating basic formulas, working with cells and rows) and PowerPoint (for example: creating a new presentation from a design template, adding and removing slides, entering and formatting text, adding speaker notes, and viewing presentations).
Preferred Qualifications
* At least 2 years of experience in pharmacy claims processing.
Apply Save jobSaved