Analyst, Eligibility Job at CVS Health (Austin)

Job Description

Establishes and maintains processes regarding billing and claims processing, insurance verification and authorization, revenue cycle management, compliance and documentation, as well as customer service and issue resolution. Reconciles and solves issues to ensure accurate billing, facilitate smooth revenue flow, maintain compliance, and provide satisfactory customer experiences.

Job Responsibility

Reviews and analyzes applications, forms, and supporting documentation to verify individuals' eligibility for healthcare programs or insurance coverage
Applies eligibility rules and regulations when evaluating information submitted by customers in support of initial or continuing eligibility determination
Compiles and evaluates information, calculating eligibility factors, and ensuring consistent and fair eligibility determinations
Escalates eligibility issues and updates member records in the appropriate database(s) to ensure accurate data
Conducts basic quality audits of eligibility uploads to ensure data integrity is clean, accurate, and consistent with specifications
Communicates regulations, rules, and policies to clients and apprises them of their rights, responsibilities, and eligibility for participation
Educates customers on basic program services and eligibility requirements
Coaches more junior colleagues in intellectual property techniques, processes, and responsibilities to help optimize eligibility reviews
Assigns tasks, sets performance goals, conducts performance evaluations, and provides training and educational development opportunities to team members

Requirements

2+ years customer service or client-facing experience in a fast-paced environment
Basic awareness of problem solving and decision making skills
Microsoft Office working experience
High School Diploma or G.E.D.

Nice to have

3+ years in eligibility or other relevant background
Proficiency in processing accurate and timely Eligibility data
Experience in EDI (Electronic Data Interchange)
Understanding of the PBM industry
Experience in a healthcare client facing role
Experience in a fast-paced environment
Knowledge of ANSI X12 834 Data Documents
Familiarity with RxClaim and/or AS400
Microsoft Excel experience
Bachelor's degree

What we offer

Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs

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Analyst, Eligibility

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