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Position Summary...

What you'll do...

The Health and Wellness Billing Team is looking for a task-oriented individual with an acute attention to details who excels at prioritization and collaboration. As an Enterprise Business Services Senior Specialist II, you will respond to third-party pharmacy audit requests, research claim details, defend pharmacy recoupments and issue corrective actions and compliance guidance to pharmacy associates. Reporting to the Billing Manager, you will communicate potential concerns, risks and trends while applying critical thinking skills to identify potential operational or procedural solutions.

Who we are...

Pharmacy Audit and Billing team that responds to third-party payer audit requests, investigates and challenges findings, while capturing insights to drive actionable intelligence to mitigate risk and promote pharmacy compliance adherence.

What you'll do...

• Support Health & Wellness in responding to third party audit requests and investigations by verifying billing and claim details for third party payers, gathering data and prescription records, tracking audit requests, and ensuring accuracy of data, discrepancies, and recoupments.

• Complete work assignments and priorities in Health and Wellness Audit by using policies, data, and resources, collaborating with managers, coworkers, customers, pharmacies, and other business partners.

• Identify priorities, deadlines, and expectations, carry out tasks, communication of progress and information, determine and recommend improvement opportunities, and adapt to and learn from change, difficulties, and feedback.

• Identify and monitor past, present, and future risks in the audit of groups under review, translating audit findings; gathering proper appeal documentation, and ensuring audit request deadlines are met.

• Maintain and store HIPAA related records that must comply with Federal and Corporate requirements.

Responsibilities Include:

• Respond to third-party audit request by reviewing the request and pulling the requested documents. Organize the documents and send to the third party. Save all the documents in the assigned folder along with read receipts.

• Track the prescriptions that are requested from the third-party vendor in a checklist for each audit and enter the information in the Inmar Audit tool that is used to run reports.

• Review the results that will be sent back for each audit to determine if an appeal is needed. Then at that point put together the appeal document request and sent to store with a deadline to receive the documents. Once documents are received then review to ensure they are correct and submit to the third-party vendor.

• Review the finals that will be sent back from the appeal and enter the data in the Inmar Audit tool by tagging the prescriptions with the correct tags that relate to the discrepancies flagged by the third party.

• Share any findings and any other information that is important in team meeting and to your manager.

Qualities we are looking for:

• Subject matter expert in the Pharmacy space

• Driven to execute and act quickly.

• Process-minded and look for opportunities to streamline for improved efficiency and effectiveness.

• Strong communication skills to interact with leadership and stakeholders.

• Organized, disciplined, and can manage multiple projects simultaneously while achieving results.

Minimum Qualifications:

• Bachelor's degree in Business, Healthcare, Compliance, or 3 years' experience in healthcare, medical billing, audit, compliance, or pharmacy field.

• Moderate to advanced Excel skills

The above information has been designed to indicate the general nature and level of work performed in the role. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job. The full Job Description can be made available as part of the hiring process.

At Walmart, we offer competitive pay as well as performance-based bonus awards and other great benefits for a happier mind, body, and wallet. Health benefits include medical, vision and dental coverage. Financial benefits include 401(k), stock purchase and company-paid life insurance. Paid time off benefits include PTO (including sick leave), parental leave, family care leave, bereavement, jury duty, and voting. Other benefits include short-term and long-term disability, company discounts, Military Leave Pay, adoption and surrogacy expense reimbursement, and more.

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You will also receive PTO and/or PPTO that can be used for vacation, sick leave, holidays, or other purposes. The amount you receive depends on your job classification and length of employment. It will meet or exceed the requirements of paid sick leave laws, where applicable.

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For information about PTO, see https://one.walmart.com/notices .

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Live Better U is a Walmart-paid education benefit program for full-time and part-time associates in Walmart and Sam's Club facilities. Programs range from high school completion to bachelor's degrees, including English Language Learning and short-form certificates. Tuition, books, and fees are completely paid for by Walmart.

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Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to a specific plan or program terms.

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For information about benefits and eligibility, see One.Walmart .

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The hourly wage range for this position is $21.00-$40.00*

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*The actual hourly rate will equal or exceed the required minimum wage applicable to the job location.

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Additional compensation in the form of premiums may be paid in amounts ranging from $0.35 per hour to $3.00 per hour in specific circumstances. Premiums may be based on schedule, facility, season, or specific work performed. Multiple premiums may apply if applicable criteria are met.

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Minimum Qualifications...

Outlined below are the required minimum qualifications for this position. If none are listed, there are no minimum qualifications.

Preferred Qualifications...

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

Finance/Accounting, Information Systems, Managing Departmental Payroll

Bachelors: Finance, Bachelors: Information Technology, Bachelors: Mathematics

Primary Location...

805 SE MOBERLY LN, BENTONVILLE, AR 72712, United States of America

Walmart, Inc. is an Equal Opportunity Employer- By Choice. We believe we are best equipped to help our associates, customers, and the communities we serve live better when we really know them. That means understanding, respecting, and valuing diversity- unique styles, experiences, identities, abilities, ideas and opinions- while being inclusive of all people.