Specialist 3rd Party Rx Ops Pharmacy Tech Services

• Responsible for the update, maintenance, auditing, and operation of third party prescription plan contracts, including entering plans into pharmacy system and reviewing all information to meet current NCPDP HIPAA standard.
• Responsible for resolving problems and questions regarding third party prescription plans from stores, claims processors, Walgreens Direct Bill contracts and other applicable parties. Identifies and recommends best practices solutions to recurring issues.
• Enters plan specifications into the appropriate systems using payer sheets, ensuring compliance with plan provisions, Walgreens Direct Bill contracts, coordination of benefits, corporate guidelines, and Federal, state, and/or local regulations.
• Develops test data for NCPDP compliance to the current HIPAA standard and conducts on-line tests to ensure appropriate claims processing and reimbursement. Identifies and implements corrective actions for test results that are not compliant with the plan specifications.
• Collaborates with third party payor and Walgreens Direct Bill contracts and appropriate Walgreens team members to ensure operational performance and compliance with the responsible third party contractor.
• Analyzes and recommends corrective actions to system discrepancies, prescription and reimbursement data, vendor changes, claims processors, etc. Experience with query databases to pull claims data.
• Maintains up-to-date knowledge about State Medicaid agencies by monitoring and reporting on bulletins and updates to claims processing and assigned web portals.
• Responsible for the update, maintenance, auditing, and operation of prescriber information,including updating and entering prescriber information into the pharmacy system and investigating any necessary information.
• Responsible for resolving questions regarding prescriber information from stores, processors, and other applicable parties. Identifies and recommends best practices.
• Utilizes skills in Excel, PowerPoint and the ability to query databases in order to assist analysts in the creation of presentations and training for store staff and supervision.
• Assists other Walgreens departments with audits, both fiscal and operational, to ensure all appropriate data is made available to accurately complete internal and external plan audits.
• May respond to federal and state issued subpoenas and coordinate access to internal corporate applications. May also perform various administrative functions, when necessary, such as scheduling meetings, coordinating group events etc).
• Acts as a liaison and partners with Provider Enrollment, Accounting, Contracting, Medicare B Operations, and Third Party Audit teams for store team members and field leadership support.

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