Position SummaryWhat you'll doThe 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 arePharmacy Analysts respond to third-party payer audit requests, investigates and challenges determinations, while capturing insights to drive actionable intelligence to mitigate risk and promote pharmacy compliance adherence.What you'll do
Support Health & 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; collaborating with managers, coworkers, customers, pharmacies, and other business partners. Identify priorities, deadlines, and expectations; carry out tasks; communication of 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.
Qualities we are looking for:
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.
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 skillsAt Walmart, we offer competitive pay as well as performance-based bonus awards and other great benefits for a happier mind, body, and wallet. Health benefits include medical, vision and dental coverage. Financial benefits include 401(k), stock purchase and company-paid life insurance. Paid time off benefits include PTO (including sick leave), parental leave, family care leave, bereavement, jury duty, and voting. Other benefits include short-term and long-term disability, company discounts, Military Leave Pay, adoption and surrogacy expense reimbursement, and more.You will also receive PTO and/or PPTO that can be used for vacation, sick leave, holidays, or other purposes. The amount you receive depends on your job classification and length of employment. It will meet or exceed the requirements of paid sick leave laws, where applicable.For information about PTO, see https://one.walmart.com/notices .Live Better U is a Walmart-paid education benefit program for full-time and part-time associates in Walmart and Sam's Club facilities. Programs range from high school completion to bachelor's degrees, including English Language Learning and short-form certificates. Tuition, books, and fees are completely paid for by Walmart.Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to a specific plan or program terms.For information about benefits and eligibility, see One.Walmart .The hourly wage range for this position is $26.00-$51.00The actual hourly rate will equal or exceed the required minimum wage applicable to the job location.Additional compensation in the form of premiums may be paid in amounts ranging from $0.35 per hour to $3.00 per hour in specific circumstances. Premiums may be based on schedule, facility, season, or specific work performed. Multiple premiums may apply if applicable criteria are met.Minimum QualificationsOutlined below are the required minimum qualifications for this position. If none are listed, there are no minimum qualifications.Minimum Qualifications: Associate's degree in Business Administration, Finance, Accounting, or related field OR 1 year's experience in accounting, medical billing, medical coding, or related area.Preferred QualificationsOutlined below are the optional preferred qualifications for this position. If none are listed, there are no preferred qualifications.Primary Location2608 Se J St, Bentonville, AR 72712, United States of AmericaWalmart, Inc. is an Equal Opportunity Employer- By Choice. We believe we are best equipped to help our associates, customers, and the communities we serve live better when we really know them. That means understanding, respecting, and valuing diversity- unique styles, experiences, identities, abilities, ideas and opinions- while being inclusive of all people.
