Medicare Part B Operations Coordinator, Revenue Cycle

$35,360 - $65,104/Yr

CVS Health - Boston, MA

Full-time - Entry Level

Boston, MA

Health and Personal Care Retailers

About the position

The Medicare Part B Operations Coordinator plays a crucial role in supporting the end-to-end claims processing for Medicare Part B at CVS Health. This position is responsible for ensuring compliance with Centers for Medicare and Medicaid Services (CMS) requirements, facilitating successful claim processing and submission through manual interventions, and supporting the Revenue Cycle Team's goal of timely and accurate billing of pharmacy and medical claims. The Coordinator will manage prescriber documentation and assist in operational improvements to reduce bad debt and legal risks.

Responsibilities

• Support activities related to Medicare Part B end-to-end claims processing.
• Ensure CVS compliance with CMS requirements for successful claim processing and submission.
• Assist in collecting and validating prescriber documentation via fax and phone outreach.
• Maintain and manage a central data repository of prescriber documentation.
• Perform root cause analysis and provide findings/suggestions to the leadership team.
• Assist in the development of action plans for continuous operational improvement.
• Provide Medicare Part B claim adjudication support to pharmacies as needed.

Requirements

• 1+ years of experience in retail pharmacy, PBM, or account management.
• 1+ years of professional experience with MS Office.
• 1+ years of professional experience with MS Access.
• Excellent diagnostic and organizational skills with strong attention to detail.
• Demonstrated ability to communicate clearly and tactfully with business partners.

Nice-to-haves

• Ability to make sound business decisions independently or through team collaboration.
• Flexibility to adapt to a changing environment.
• Knowledge of medical billing and/or Medicare Part B Policy and Regulations.
• Rhode Island Pharmacy Technician License (Tech II).
• CPhT Certification by PTCB.

Benefits

• Store discount
• Employee stock purchase plan
• Paid holidays
• Disability insurance
• Health insurance
• Dental insurance
• 401(k)
• Tuition reimbursement
• Paid time off
• Vision insurance
• Life insurance