Coordinator, Bill Processing Support - Cmi
Position SummaryWhat you'll doResolves 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.
Completes work assignments and priorities by using policies, data, and resources; collaborating with managers, co-workers, customers, and other business partners; identifying priorities, deadlines, and expectations; carrying out tasks; communicating progress and information; determining and recommending ways to address improvement opportunities; and adapting to and learning from change, difficulties, and feedback.
Complies with company policies, procedures, and standards of ethics and integrity by implementing related action plans; using the Open Door Policy; and applying these in executing business processes and practices.
Live our ValuesCulture Championo Models the Walmart values to foster our culture; holds oneself accountable; and supports Walmart's commitment to communities, social justice, corporate social responsibility, and sustainability; maintains and promotes the highest standards of integrity, ethics and compliance.
Servant Leadershipo Is consistently humble, self-aware, honest, and transparent.
Embrace ChangeCuriosity & Courageo Demonstrates curiosity and a growth mindset; supports innovation and intelligent risk-taking; and exhibits resilience in the face of setbacks.
Digital Transformation & Changeo Implements and supports continuous improvements and willingly embraces new digital tools and ways of working.
Deliver for the CustomerCustomer Focuso Delivers results while putting the customer first and applying an omnimerchant mindset and the EDLP and EDLC business models to all plans.
Strategic Thinkingo Adopts a broad perspective that considers data, analytics, customer insights, and different parts of the business when making plans.
Focus on our AssociatesDiversity, Equity & Inclusiono Embraces diversity in all its forms and actively supports diversity of ideas and perspectives, as well as diversity goal programs.
Collaboration & Influenceo Builds strong and trusting relationships with team members and business partners; works collaboratively to achieve objectives; communicates withimpact to a range of audiences; and demonstrates energy and positivity for own work.
Talent Managemento Contributes to an environment allowing everyone to bring their best selves to work, demonstrates engagement and commitment to the team, and recognizes others'contributions and accomplishments.
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 Primary Location 608 SW 8TH ST, BENTONVILLE, AR 72712-6207, United States of America Recommended Skills Adaptability Administration Auditing Billing Business Processes Claim Processing Estimated Salary: $20 to $28 per hour based on qualifications.
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.
Completes work assignments and priorities by using policies, data, and resources; collaborating with managers, co-workers, customers, and other business partners; identifying priorities, deadlines, and expectations; carrying out tasks; communicating progress and information; determining and recommending ways to address improvement opportunities; and adapting to and learning from change, difficulties, and feedback.
Complies with company policies, procedures, and standards of ethics and integrity by implementing related action plans; using the Open Door Policy; and applying these in executing business processes and practices.
Live our ValuesCulture Championo Models the Walmart values to foster our culture; holds oneself accountable; and supports Walmart's commitment to communities, social justice, corporate social responsibility, and sustainability; maintains and promotes the highest standards of integrity, ethics and compliance.
Servant Leadershipo Is consistently humble, self-aware, honest, and transparent.
Embrace ChangeCuriosity & Courageo Demonstrates curiosity and a growth mindset; supports innovation and intelligent risk-taking; and exhibits resilience in the face of setbacks.
Digital Transformation & Changeo Implements and supports continuous improvements and willingly embraces new digital tools and ways of working.
Deliver for the CustomerCustomer Focuso Delivers results while putting the customer first and applying an omnimerchant mindset and the EDLP and EDLC business models to all plans.
Strategic Thinkingo Adopts a broad perspective that considers data, analytics, customer insights, and different parts of the business when making plans.
Focus on our AssociatesDiversity, Equity & Inclusiono Embraces diversity in all its forms and actively supports diversity of ideas and perspectives, as well as diversity goal programs.
Collaboration & Influenceo Builds strong and trusting relationships with team members and business partners; works collaboratively to achieve objectives; communicates withimpact to a range of audiences; and demonstrates energy and positivity for own work.
Talent Managemento Contributes to an environment allowing everyone to bring their best selves to work, demonstrates engagement and commitment to the team, and recognizes others'contributions and accomplishments.
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 Primary Location 608 SW 8TH ST, BENTONVILLE, AR 72712-6207, United States of America Recommended Skills Adaptability Administration Auditing Billing Business Processes Claim Processing Estimated Salary: $20 to $28 per hour based on qualifications.
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