The Managed Care Appeals Analyst will research closed $0 balance accounts for underpayment amounts due from payors per established contracts, ensuring accurate payments and creating appeals when accounts are not reimbursed according to contracts.
Compensation
Pay Range: $23.00 - $28.88 per hour
Responsibilities
Perform daily systematic reviews of $0 balance accounts for appropriate contractual reimbursement
Post adjustments and patient responsibility at time of account review
Use payor contract, remit, and audit note to troubleshoot and identify reimbursement efficiencies
Create high level, detailed appeals identifying unpaid services and supporting information
Contact payor sources to confirm eligibility, coordination of benefits, patient responsibility, DRG, APR-DRG, and other denial or claims issues
Responsible for accurate billing and collection of third party and patient payments for pharmacy products and services.
Compensation
The actual compensation that you will be offered will depend on a variety of factors including geography, skills and abilities, education, experience and other relevant factors.
Responsibilities
Submit timely, accurate invoices to payer
Determine quantities and prices for billed products and services
Verify services and products are correctly authorized
Ensure Medicare documentation is received and submitted to Danville
Review reports to maximize generic substitution opportunities
Requirements
High School Diploma or equivalent
Pharmacy Technician license
PTCB or ExCPT certification
Nice to have: Retail environment experience
Nice to have: Prior work experience with Walgreens
