Account Manager, Billing %26 Collections - Walgreens Specialty Pharmacy

Job Summary:

The Account Manager, Billing & Collections is responsible for managing the day-to-day accounting and audit activities of the service providers as it relates to a specific payer segment. Responsible for escalated A/R matters as they relate to the B&C area and provides advanced accounting skills to the B&C area as it relates to all business units across Walgreens. 

Job Responsibilities:

• Manages the day-to-day activities of Walgreens order to cash healthcare processes for billing and collections related to a specific payer segment (e.g. commercial Rx Card Payers, Government Payers, Employer/ Institutional Payers, and Medical) across all Walgreens' business units. Monitors cash flow, days sales outstanding (DSO), and bad debt losses for payer segment by business to ensure profitability measures are met and maintained.  Monitors billing requirements and receivables pursuant to contracts with third party payers or government programs.
  
• Manages and audit transactions processed by the Service Provider. Ensures compliance with federal, state, and local governments, third party contracts, company policy, and general accounting practices.
  
  
  
  Verifies third party audit requests are in compliance with government regulations and contract terms and reviews third party audit findings. Interacts with the service provider and affected stores to address issues / claims and correct error root-causes and implements remedial projects.
  
• Manages and analyzes account summaries of outstanding receivable balances for negotiations or settlements. Determines appropriateness and initiates discussions to settle or discount the outstanding receivable balance, after other collection techniques have been exhausted by the Service Provider. Approves adjustments to claim balances and delinquent account transfers to collection agencies according to WAG procedures and policies.
  
• Manages the centralized identification, correction, and research of third party exceptions, and recommends operational changes necessary to reduce rejects, audit losses and overpayments from Third Party plans. Reviews and ensures correct processing by service provider of retroactive eligibility requests and requests where the wrong plan was billed. Approves edits to claim billing records according to WAG procedures and policies.
  
• Acts as the first point of contact for escalation issues from the service provider regarding unresolved unknown deductions on payments received from payer or failure of payer to comply with contract terms as well as for billing and collections issues/ claims.
  
• Recommends and establishes billing forms according to WAG procedures and policies. Approves disbursements and adjustments submitted by the service provider according to WAG procedures and policies.
  
• Develops procedures for new processes for service provider and assists in the transition. Recommends changes or enhancements to ensure “best practice” policies and procedures to gain synergies across all lines of business units. Reviews and advises service provider regarding billing and accounting related contract matters.
  
• Develops strategies and new techniques to eliminate chargebacks or bad debt losses,, including recommended changes to Intercom Plus, Scriptmed, IDX, etc.  Makes recommendations and interacts with Pharmacy Services, Specialty Pharmacy Operations, Long Term Care Pharmacy Operations, and Take Care Clinic Operations to drive solutions to reduce losses.
  
• Supports B&C Manager in the formulation of new strategies and ventures relating to accounts receivable business. Recommends process improvements and service provider action plans.
  
• Trains new B&C accountants and audits adjustment approvals completed by B&C accountants to evaluate skills and comprehension related to training and responsibilities.