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Manager, Billing & Coding Compliance

Address: 108 WILMOT RD,DEERFIELD,IL,60015-05145-01108-2

Job ID 982856BR
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Job Summary

The Manager of Billing and Coding Compliance is accountable for all medical coding, billing, and documentation requirements for Walgreens Health services. The Manager is responsible for ensuring proposed revenue opportunities from programs and partnerships are compliant with regulatory guidelines and policies (including Medicare). Working with other Walgreens teams, develop and implement a medical billing internal audit program, policies and procedures.

Job Responsibilities
  • Responsible for providing industry standard and legally and regulatorily compliant revenue capture, medical coding, billing, and documentation requirements for all new and existing revenue streams to support Walgreens Healths strategic growth.
  • Manages third party claim administrator activities, including oversight of guidelines for Claim Handling. Best Practices, Client Service, Litigation, Billing, etc. for a successful claim operation.
  • Ensures current and comprehensive understanding of the scope of practice, requirements for various provider types, federal and state regulations, and payer requirements.
  • Develops and implements a medical services billing and internal audit program to optimize revenue and minimize compliance risk.
  • Develops and maintains policies and procedures for Walgreens Health to ensure compliance with all relevant billing and coding laws, standards, and regulations.
  • Identifies medical billing risks and develops policies, procedures and processes to mitigate.
  • Communicates changes or updates to existing medical billing coding laws, regulations, policies, and procedures as required in a timely and efficient manner.
  • Develops and implements efficient workflow processes to manage errors and or denials.
  • Provides oversight of the development of billing and coding documentation, training materials, correspondence.
  • Other duties as required by executive management.
An Equal Opportunity Employer, including disability/veterans

About Walgreens Boots Alliance
Walgreens Boots Alliance (Nasdaq: WBA) is a global leader in retail pharmacy, impacting millions of lives every day through dispensing medicines, and providing accessible, high-quality care. With more than 170 years of trusted healthcare heritage and innovation in community pharmacy, the company is meeting customers’ and patients’ needs through its convenient retail locations, digital platforms and health and beauty products.
Including equity method investments, WBA has a presence in more than 25 countries, employs more than 450,000 people and has more than 21,000 stores.
WBA’s purpose is to help people across the world lead healthier and happier lives. The company is proud of its contributions to healthy communities, a healthy planet, an inclusive workplace and a sustainable marketplace. WBA is a participant of the United Nations Global Compact and adheres to its principles-based approach to responsible business.
WBA is included in FORTUNE’s 2021 list of the World’s Most Admired Companies. This is the 28th consecutive year that WBA or its predecessor company, Walgreen Co., has been named to the list.
More company information is available at www.walgreensbootsalliance.com

Basic Qualifications

  • A Bachelor’s Degree in Health Information Management, Health Informatics, Healthcare Administration, or related field of study is required plus 2 years’ experience; OR High School GED with a minimum of five years’ experience in professional or facility coding, and extensive knowledge of various compliance rules and regulations in the coding, billing, and reimbursement areas
  • Knowledge of HEDIS and CMS risk adjustment coding
  • Experience with developing, conducting, and enforcing internal audit and compliance programs
  • Current coding certification and in good standing through AHIMA or AAPC
  • At least 1 year of direct leadership, indirect leadership and cross functional team leadership.
  • Willing to travel up to at least 5 percent of the time for business purposes within state and out of state.

Preferred Qualifications

  • Previous supervisory experience, data driven, and strong organizational skills with an ability to manage multiple projects are preferred
  • Prior experience in an ambulatory or tele health setting helpful
  • Prior experience in a cross functional environment helpful
  • Strong collaboration and relationship building skills
  • Ability to work in a highly ambiguous environment strongly preferred
  • Strong communications skills, both verbal and written ability to convey complex legal and regulatory compliance topics to broad audiences in an easily digestible fashion

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