About the position
As a Coordinator in the Revenue Cycle at CVS Health, you will play a crucial role in the pharmacy operation setting at our Patient Financial Service Centers. Your primary responsibility will be to support the claims follow-up, denial, and appeals processes, directly impacting patients' lives by ensuring that all payer payments are appropriately allocated. This role is essential in alleviating the financial burden on patients by ensuring that their claims are processed correctly and efficiently. In this position, you will work out of an unbilled queue and aged work list queue, processing denials, unpaid claims, and primary and secondary billing efforts for both commercial and government payers. You will follow up on payment denials and underpayments on patient accounts, collaborating with payers to ensure that all claims have been processed correctly and applied to the appropriate accounts. Your attention to detail will be vital as you continually monitor the billing and collections process, ensuring that all communication, collection efforts, and adjustments are documented and recorded on patient accounts. You will perform detailed research of claims and outstanding balances, identifying root causes and resolving trends and issues with minimal supervision. Utilizing both paper and electronic billing systems, you will escalate and appeal claims for expedited resolution. Analyzing and understanding Explanation of Benefits (EOBs) and Remittance advice breakdowns will also be part of your responsibilities, requiring strong analytical skills and a thorough understanding of the billing process. This hybrid role requires you to be in the Orlando, FL office four days a month, with a schedule of Monday to Friday from 8:00 AM to 4:30 PM EST. Your contributions will be pivotal in ensuring that CVS Health continues to deliver enhanced human-centric health care in a rapidly changing world.
Responsibilities
- Process denials, unpaid claims, and primary and secondary billing efforts for both commercial and government payers.
- Follow up on payment denials and underpayments on patient accounts, ensuring claims are processed correctly.
- Monitor the billing and collections process, documenting all communication and collection efforts on patient accounts.
- Perform detailed research of claims and outstanding balances, identifying root causes and resolving issues.
- Utilize both paper and electronic billing systems for claims processing.
- Escalate and appeal claims for expedited resolution.
- Analyze and understand Explanation of Benefits (EOBs) and Remittance advice breakdowns.
Requirements
- 1 to 3 years of experience in Medical, Healthcare Insurance claims collection, and/or Pharmacy Reimbursement/Accounts Receivable.
- Experience in MS Office, specifically MS Excel functions.
- Must live within a 1 hour commute to the Orlando office.
Nice-to-haves
- Billing experience in pharmacy and/or medical coding and billing with a full understanding of Pharmacy, Medical, and Pharmacy DME claims.
- Ability to work with a highly accountable team in a fast-paced environment and quickly learn complex computer applications.
- Effective communication skills and excellent customer service demeanor in challenging situations.
- Strong analytical, organizational, communication, and interpersonal skills.
- Excellent research, analytical, and problem resolution skills.
- Strong mathematical skills and understanding of account ledger - debits and credits.
- Proficient computer skills, including experience with Microsoft and Windows-based applications.
Benefits
- Full range of medical, dental, and vision benefits.
- 401(k) retirement savings plan.
- Employee Stock Purchase Plan for eligible employees.
- Fully-paid term life insurance plan for eligible employees.
- Short-term and long-term disability benefits.
- Numerous well-being programs and education assistance.
- Free development courses.
- CVS store discount and discount programs with participating partners.
- Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year.
