Specialist RCM - Quality Validation MM - Remote
W
Walgreens
📍 DEERFIELD, IL, United States
Job Description
**Job Description:**
**Job Summary:**
Responsible for validating patient orders, performing quality assurance with items to be shipped, monitors pre-shipment procedures and coordinates distribution review. Assists with meeting Revenue Cycle Management goal targets by understanding the verification process, the logistics process and working with J-Codes, diagnosis codes, route of administration, place of service, IPA claims, Medicare B & D billing, Major Medical and PBM.
**Job Responsibilities:**
+ Utilizes all available resources to review and verify pre-shipment information for ordered items; verifies patient insurance coverage and completes a full Medical Verification of medications, administration supplies, and related pharmacy services through proper investigation into either major medical benefits or pharmacy benefits.
+ Investigates prior authorization and any other claim rejections.
+ Audits Major Medical claims for accuracy and document findi...
**Job Summary:**
Responsible for validating patient orders, performing quality assurance with items to be shipped, monitors pre-shipment procedures and coordinates distribution review. Assists with meeting Revenue Cycle Management goal targets by understanding the verification process, the logistics process and working with J-Codes, diagnosis codes, route of administration, place of service, IPA claims, Medicare B & D billing, Major Medical and PBM.
**Job Responsibilities:**
+ Utilizes all available resources to review and verify pre-shipment information for ordered items; verifies patient insurance coverage and completes a full Medical Verification of medications, administration supplies, and related pharmacy services through proper investigation into either major medical benefits or pharmacy benefits.
+ Investigates prior authorization and any other claim rejections.
+ Audits Major Medical claims for accuracy and document findi...