Manager, Billing Pharmacy Clinical Services - Bentonville, United States - Wal-Mart

Description

Position Summary...

What you'll do...

Join the Health & Wellness Pharmacy Medical Billing Team as a Manager, Medical Billing supporting the Pharmacy Clinical Services business.

In this role, you will assist the Sr. Manager, Medical Billing in ensuring billing for medical claims within the Pharmacy are successful.


This role will:

• Be responsible for collaborating with internal Payer Relations, Operations, Revenue Cycle Management teams as well as third party vendors to ensure Medical Insurance Plans are set up and billed for Clinical Services.
• Provide monthly reporting on medical claims
• Implement and maintain processes to report updates/escalations to leadership and the broader organization; and
• Scrutinize Claims Submissions and Remittances, Plan Fee Schedules, and communicate discrepancies/solutions if identified.

You'll Sweep us off our feet if...

• You have experience in Billing, Revenue Cycle Management, Coding & managing complex projects cross-functionally.
• You possess strong collaboration skills and highly adaptable to changing priorities.
• You have strong financial acumen.
• You are experienced with Microsoft Suite of Tools: Excel, Visio, PowerPoint

Additional responsibilities:

• Researches complex bill review data to identify trends and implement best practices by running and analyzing reports ; determining root causes of increased charges or payment allowances; determining solutions to negative trends; maximizing benefits of positive trends (for example, applying cost savings across multiple states); evaluating performance metrics (for example, reconsideration logs, savings dashboard); partnering with other teams (for example, analytics, senior coordinators, case managers, medical providers, defense counsel, regulatory agencies); and developing and maintaining workflow processes to ensure accurate implementation.
• Ensures compliance with laws and regulations by researching changes to federal, state, and local laws and regulations impacting insurance payment of medical bills; ensuring changes in state reporting requirements, periodic fee schedules, and applicable laws and regulations are applied to bill review process and procedures; evaluating auditing results to ensure the audit forms measure the desired quality results ; modifying the auditing process as regulatory agency requirements change; building and maintaining relationships with other bill processing teams, state agencies, the Legal department, and bill review suppliers to clarify regulations or implement systematic changes required for compliance; evaluating vendor processors quality audit results, providing feedback on results to vendor processors, and creating action plans to correct deficiencies; and ensuring regulatory certifications for state and federal utilization and bill review are obtained.
• Manages vendor contracts by holding vendors accountable for delivering contracted services; ensuring contract language meets business and compliance requirements; monitoring workflow and changing it to meet vendor requirements to obtain discounted services; and ensuring claims team complies with contract requirements.
• Serves as subject matter expert by educating internal teams about bill review process and system changes; providing supporting information and education related to litigation of bill review to defense counsel; analyzing bill review litigation trends with adjusting teams and Legal department to develop solutions for implementation; collaborating with third party administrators to improve processes ; drafting letters and developing explanation of review statements for multiple states; educating team and vendor processors on pre-litigation best practices; and participating and leading special projects to enhance bill payment processes.
• Manages customer service and vendor call centers by reviewing reports on call time averages to make sure calls are processed efficiently and effectively; ensuring responses to inquiries regarding pharmacy and medical billing from internal and external stakeholders; and identifying and resolving global trends on escalated issues (for example, unprocessed hospital bill complaints).
• Coordinates, completes, and oversees job-related activities and assignments by developing and maintaining relationships with key stakeholders; supporting plans and initiatives to meet customer and business needs; identifying and communicating goals and objectives; building accountability for and measuring progress in achieving results; identifying and addressing improvement opportunities; and demonstrating adaptability and promoting continuous learning.
• Provides supervision and development opportunities for associates by hiring and training; mentoring; assigning duties; providing recognition; and ensuring diversity awareness. Ensures compliance with company policies and procedures and supports company mission, values, and standards of ethics and integrity by implementing related action plans; utilizing and supporting the Open Door Policy; and providing direction and guidance on applying these in executing business processes and practices.

#LI-KL

Live our Values

Culture Champion

• Models the Walmart values to foster our culture; holds oneself and others 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 Leadership

• Acts as an altruistic servant leader and is consistently humble, self-aware, honest, and transparent.

Embrace Change

Curiosity & Courage

• Demonstrates curiosity and a growth mindset; fosters an environment that supports learning, innovation, and intelligent risk-taking; and exhibits resilience in the face of setbacks.

Digital Transformation & Change

• Seeks and implements continuous improvements and encourages the team to leverage new digital tools and ways of working.

Deliver for the Customer

Customer Focus

• Delivers expected business results while putting the customer first and consistently applying an omni-merchant mindset and the EDLP and EDLC business models to all plans.

Strategic Thinking

• Adopts a holistic perspective that considers data, analytics, customer insights, and different parts of the business when making plans and shaping the team's strategy.

Focus on our Associates

Diversity, Equity & Inclusion

• Identifies, attracts, and retains diverse and inclusive team members; builds a high-performing team; embraces diversity in all its forms; and actively supports diversity goal programs.

Collaboration & Influence

• Builds strong and trusting relationships with team members and business partners; works collaboratively and cross-functionally to achieve objectives; and communicates with energy and positivity to motivate, influence, and inspire commitment and action.

Talent Management

• Creates a discipline and focus around developing talent, promotes an environment allowing everyone to bring their best selves to work, empowers associates and partners to act in the best interest of the customer and company, and regularly 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.

Minimum Qualifications:

Bachelor's degree in Business Management, Accounting, Project Management, Healthcare Management, or related field and 1 year's experience in insurance claims, accounting, or related area OR 3 years' experience in insurance claims, accounting, or related area.

Preferred Qualifications...

Outlined below are the optional preferred qualifications for this position. If none are listed, there are no preferred qualifications.


Masters:
Business Administration

Primary Location...

2608 Se J St, BENTONVILLE, AR 72712, United States of America