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 &Amp; 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 and Collaborating With Managers, Coworkers, Customers, Pharmacies, And Other Business Partners. Identify Priorities, Deadlines, And Expectations; Carry Out Tasks; Communicate 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.

Responsibilities Include:

• 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 send it to the 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.

Minimum Qualifications:

• 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.

Job Benefits:

• Benefits: Walmart Generally Offers Health Insurance Options, Including Health, Dental, And Vision Insurance, For Eligible Employees And Their Dependents.
• Retirement Plans: Walmart Often Offers Retirement Plans Such As 401(K) And Company Matching, Allowing Employees To Save For Their Future. Affiliate Discounts: Walmart Employees Often Earn Money On Merchandise Sold In Walmart Stores And Online.
• Vacation: This Includes Vacation Days, Personal Days, And Statutory Holidays, Which May Vary Depending On The Employee\'s Grade And Level.
• Sick Leave: Walmart Often Provides Paid Sick Leave For Employees Who Must Be Absent Due To Illness Or Medical Appointments.
• Life Insurance: Basic Life Insurance Is Sometimes Provided Free Of Charge To Employees, And Additional Coverage May Be Available For Purchase.
• Employee Assistance Program (EAP): Eaps Often Provide Confidential Counseling And Resources To Employees Facing Personal Or Employment Issues.
• Educational Assistance: Some Positions At Walmart May Offer Educational Benefits Such As Tuition Reimbursement Or Continuing Education Assistance.
• Career Development: Walmart Often Offers Opportunities For Career Growth And Advancement Within The Company.
• Flexible Hours: Depending On The Job, Walmart May Offer Flexible Hours Options To Meet Different Needs.
• Employee Recognition Programs: Walmart May Have Programs To Recognize And Reward Outstanding Employee Performance.
• Wellness Program: Walmart Is Known For Offering Wellness Programs That Promote Employee Health And Well-Being.
• Maternity/Paternity Leave: Walmart Usually Offers Some Form Of Paid Maternity And Paternity Leave To Eligible Employees.