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Job Summary

Creates and maintains reports for management that provide indepth information on the reimbursement trends. Assists the reimbursement department in documentation of their procedures and with identifying opportunities for process improvements. Compiles with and communicates best practices and processes to minimize inadvertent or inappropriate direct patient billing.

Job Responsibilities (listed in order of importance and/or time spent)

• Develops reports on billing activities and identifies positive and negative trends for management.  May identify and recommend potential corrective actions to address adverse trends.
• Develops reports on competitive bid market trends and help identify underperforming markets.
  
  
  
  
• Create and submit monthly reports to tax department, Humana Utilization, BCBS sales and distribution IDB for cap sales.
• Tracks billing issues/projects with insurance companies, including system load errors and application of incorrect copayments; maintains the Contract Issues Spreadsheet on the Shared Drive.
• Documents billing processes and procedures, many of which may be location specific due to Medicaid provisions that concurrently optimize revenue recovery for complex medical billing transactions while minimizing patient inconvenience and/or inappropriate direct patient billing.
• Directly contacts private insurance carriers, Medicare, and Medicaid providers to ascertain, document, and deploy information regarding appropriate plan provisions and restrictions on reimbursements; Obtains from third party payors, fees for new services and tracks and communicates to Billing.
• Documents billing procedures for facility, ensuring compliance with, Federal and State regulations, private insurance programs, and Walgreens accounting, billing, and control requirements.
• Utilizes knowledge to handle forecasting, chargebacks and dispensing fee reporting.
• May identify opportunities for process improvements in the reimbursement workflow and with the automated billing process.
• Addresses billing inquiries from on-site locations and uses such information to identify inappropriate trends. 
• Performs other duties as assigned.