Medical Reimbursement Representative Job at CVS Health (Work at Home, Arizona)

Director, Payer Policy

The Director, Payer Policy is responsible for shaping, influencing, and executin...

Location

United States

Salary:

164900.00 - 247000.00 USD / Year

NeoGenomics Laboratories

Expiration Date

Until further notice

Requirements

Bachelor’s degree in Business, Health Policy, Science, or related field required
Advanced degree (MBA, MPH, MHA, MS, PharmD, PhD) preferred
10 years’ experience required in of payer relations, market access, reimbursement, or managed care leadership, preferably within diagnostics, laboratory services, or biotech
Deep expertise in payer policy, coding, coverage frameworks, and reimbursement economics
Demonstrated experience influencing coverage decisions and navigating LBM organizations
Strong understanding of oncology testing, precision medicine, and relevant regulatory pathways
Proven track record of leading cross-functional teams in complex, matrixed environments
Experience shaping evidence strategy and collaborating with Medical Affairs/HEOR teams preferred
Experience in laboratory or diagnostic reimbursement environments preferred

Job Responsibility

Develop and execute a multi-year payer strategy to secure broad, durable coverage for NeoGenomics’ oncology diagnostic portfolio
Lead payer policy engagement, including proactive outreach, policy reviews, coverage advocacy, and targeted education on new and emerging technologies
Define and communicate NeoGenomics’ payer value proposition, leveraging clinical evidence, HEOR, real-world data, and patient outcomes
Partner with Medical Affairs, Clinical, and R&D to influence evidence plans needed to support positive coverage decisions
Oversee payer policy monitoring and regulatory surveillance
communicate changes and recommended actions to internal stakeholders
Ensure payer contracts, policies, and billing operations are fully aligned to maximize reimbursement yield and reduce leakage
Advocate directly with payer Medical Directors, policy teams, and LBMs to support positive coverage and overturn restrictive decisions
Develop and present scientifically grounded, evidence-based dossiers and materials tailored to payer needs
Support preparation of clinical, economic, and outcomes evidence that strengthens the payer value story

What we offer

Career coaches
Many training opportunities
Highly competitive benefits with a variety of HMO and PPO options
Company 401k match
Employee Stock Purchase Program
Tuition reimbursement
Leadership development
16 days of paid time off plus holidays
Wellness courses
Highly engaged employee resource groups

Fulltime

New

Claim Resolution Representative III

With latitude for initiative and independent judgment within department guidelin...

Location

United States of America , Rochester

Salary:

19.62 - 26.49 USD / Hour

University of Rochester

Expiration Date

Until further notice

Requirements

Associate's degree in business administration required
2 years of hospital/professional Patient Accounting, Consumer Collections experience, or Certification obtained from a nationally accredited billing program (i.e., Certified Medical Billing Specialist CMBS, Certified Medical Records Technician CMRT, Certified Medical Reimbursement Specialist CMRS) required
Or an equivalent combination of education and experience
Ability to type 25 wpm Required

Job Responsibility

Managing professional hospital accounts
Resolving balances of aged insurance accounts
Making independent decisions as to the processes necessary to collect denied insurance claims, no response accounts, and investigating resolving billing issues
Maintaining a detailed knowledge of billing requirements and regulations
Representing the department and Strong Memorial Hospital (SMH) in a professional manner, protecting confidentiality of patient information
Completes follow up activities on denied, unpaid, or under-paid accounts
Maintains a thorough knowledge of Professional Billing
Identify and clarify billing issues, payment variances and/or trends that require management intervention
Research and respond to third party correspondence, receive phone calls, explain policies and procedures
Participate in department staff meetings, education classes and training

Fulltime

New

Self-Pay Collection Representative III

Responsible for collecting receivables due from patient/responsible parties. Ide...

Location

United States of America , Rochester

Salary:

19.62 - 26.49 USD / Hour

University of Rochester

Expiration Date

Until further notice

Requirements

Associate's degree and 3 years of hospital patient accounting or consumer collections experience required
Or equivalent combination of education and experience
Certification obtained from a nationally accredited billing program (i.e., Certified Medical Billing Specialist CMBS, Certified Medical Records Technician CMRT, Certified Medical Reimbursement Specialist CMRS) upon hire preferred

Job Responsibility

Resolves receivables due from patients
Identifies and prepares for appropriate action of those accounts which cannot be resolved amicably and requires legal or collection activity
Makes recommendation for write-off, resolves credit balances by, requests transfers and refunds, etc.
Documents and formalizes all actions to ensure compliance with university and legal requirements
Maintains records for effective reporting of efforts
Responds to patient written and verbal inquiries
Negotiates installment payment arrangements with the guarantor or a financially responsible individual that are equitable to both URMC and individual
Interacts with ancillary areas which impact receivables to resolve A/R problems and address patient problems delaying payment
Maintains a general knowledge of billing and collection regulations and procedures which affect A/R
Other duties as assigned

Fulltime

Appeals Specialist I

Responsible for all activities associated with requests for Provider Billing Dis...

Location

United States , Portland

Salary:

25.00 - 30.00 USD / Hour

Apex Systems

Expiration Date

Until further notice

Requirements

Excellent verbal and written communication skills
Intermediate computer skills (e.g. Microsoft Word, Excel, Outlook)
Knowledge of medical terminology, anatomy and coding (CPT, DX, HCPCs)
Knowledge of claims processing and clinical services operations
Demonstrated initiative and analytical ability in identifying problems, researching issues, developing solutions, and implementing a course of action
Ability to listen and communicate appropriately in a manner that promotes positive, professional interaction while maintaining confidentiality and sensitivity in all aspects of internal and external contacts
Ability to present complex medical and reimbursement information to others and to be diplomatic and persuasive regarding health plan benefits, claims and eligibility
Ability to switch from one task or type of work to another as the business needs require
Ability to effectively prioritize work to meet strict timelines while maintaining quality and consumer centric focus
High school diploma or GED and a minimum 4 years’ experience in customer Service, Claims, or Clinical Services or equivalent combination of education and work experience

Job Responsibility

Responsible for all activities associated with appeal analysis, decision-making and closure
Appeal Intake – Validate intake determinations regarding timeliness, member benefits, employer group, and provider contract provisions for each appeal. Document information in appropriate system
Appeal Analysis – Review claim coding and claim processing history, medical policy and reimbursement policies, regulatory and legal requirements, benefit contracts, and/or provider contracts. Collect and catalogue supporting documentation and formulate an appeal recommendation. Document information in appropriate system. Apply knowledge and experience to answer a variety of increasingly complex inquiries from members, providers, and provider representatives. Collaborate effectively with coding specialists, appeal nurses, physician reviewers, and others as necessary to reach timely decisions on appeals
Decision & Closure – Make non-clinical appeal determinations as permitted by department business processes and guidelines. Follow department’s processes to receive a clinical review and decision from licensed health professionals. Present complex cases to appeal panels, document decisions, communicate determinations to members, providers or their representatives. Document information in appropriate system(s)
External review process – Oversee set-up of appeals for external review organizations, including document collection and coordination, communication with all parties, and other responsibilities as an intermediary between the provider and the external review organization. Ensure external review information is documented in appropriate system. Prepares letters and cases for external review as needed. Implement external review decisions
Interpersonal and Communication – Provide information, education and assistance to members, providers, and their representatives. Facilitate the member’s or provider’s’ understanding of the appeal process and of the information necessary to effectively process an appeal. Be a courteous advocate to the member or provider when requesting supporting information. Work cooperatively and effectively across all business areas to resolve
Systems and data – Track appeals in appropriate systems and assist in the maintenance of files. Assist with compilation of reports on appeals, including trends, number of cases, decisions, suggestions for process improvement, types of appeals, and compliance with timelines
Support, apply and promote Provider or Member Appeal Policies & Procedures
Adhere to dependability, customer focus, and all performance criteria as established by the department including: timeliness, production, and quality standards for all work
Manage a defined caseload within department productivity and quality expectations and provide back up for other appeals staff

What we offer

Medical, dental, vision, life, disability, and other insurance plans
ESPP (employee stock purchase program)
401K program with company match after 12 months
HSA (Health Savings Account on the HDHP plan)
SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions
Corporate discount savings program
On-demand training program
Access to certification prep and a library of technical and leadership courses/books/seminars after 6+ months of tenure
Certification discounts and other perks to associations that include CompTIA and IIBA
Dedicated customer service team for Consultants

Fulltime

Associate Director Biostatistics

Amgen is expanding its global Biostatistics capabilities, with Amgen India (AIN)...

Location

India , Hyderabad

Salary:

Not provided

Amgen

Expiration Date

Until further notice

Requirements

Doctorate in Statistics/Biostatistics (or related subject with high statistical content) with at least 12+ years of post-graduate statistical experience in the pharmaceutical industry or medical research
Master’s degree in Statistics/Biostatistics (or related subject with high statistical content) with at least 16+ years of post-graduate statistical experience in the pharmaceutical industry or medical research

Job Responsibility

Provide sound statistical guidance to clinical development, reimbursement, and medical affairs
Oversee statistical contributions to protocols, randomization specifications, statistical analysis plans (SAPs), clinical study reports (CSRs), and key trial documents
Ensure alignment of study design and analysis with scientific rigor, regulatory requirements, and Amgen policies
Collaborate cross-functionally with global teams to deliver high-quality analyses, publications, and regulatory filings
Contribute to innovative trial designs, advanced methodologies, and process improvement initiatives
Execute biostatistical strategies across the product lifecycle, from early development through post-marketing
Provide consultancy and training to colleagues across R&D
Support governance of outsourced statistical activities, ensuring adherence to Amgen standards and regulatory compliance
Represent Biostatistics in cross-functional and external interactions (e.g., with regulatory agencies, investigators, or data monitoring committees)
Drive technology adoption leveraging AI capabilities to streamline statistician’s work

What we offer

Vast opportunities to learn and develop within our global organization
Diverse and inclusive community of belonging, where teammates are empowered to bring ideas to the table and act
Generous Total Rewards Plan comprising health, finance and wealth, work/life balance, and career benefits

Medical Customer Service Representative

We are looking for experienced Medical Customer Service Representatives to join ...

Location

United States , Columbus, Ohio

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Minimum of 2 years of experience in medical billing, collections, or customer service
Familiarity with basic medical terminology and patient interaction protocols
Proficiency in handling inbound call center operations related to patient inquiries
Strong skills in processing patient billing and resolving account discrepancies
Ability to establish and manage payment plans using online bill pay platforms
Experience assisting customers and addressing their account concerns
Knowledge of insurance policies, claims reconciliation, and refunds
Excellent communication and problem-solving skills with a customer-centric approach

Job Responsibility

Handle patient accounts promptly to minimize receivables and reduce bad debts
Monitor and manage payment plans in compliance with established guidelines
Consult with patients to address their financial responsibilities, insurance benefits, and payment options
Process delinquent accounts by coordinating with external collection agencies
Review and manage bankruptcy paperwork and deceased patient accounts
Promote a patient-focused approach to resolving balances and account discrepancies
Calculate and collect payments accurately, ensuring compliance with payment policies
Research accounts receivable issues and reconcile claims effectively
Provide support to scheduling teams by identifying insurance contracts and reimbursement policies
Collaborate with team members and leadership to suggest workflow improvements and enhance service experiences

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

New

Exec Support Admin I

Under general guidance and with significant latitude for independent judgment, i...

Location

United States of America , Rochester

Salary:

63815.00 - 95723.00 USD / Year

University of Rochester

Expiration Date

Until further notice

Requirements

Bachelor’s degree required
3 years of relevant experience required
or equivalent combination of education and experience required
Experience in an executive-level or healthcare administrative office setting preferred
Excellent interpersonal and communication skills required
Ability to interact with a broad range of internal and external constituencies, including senior executives required
Exceptional organizational and time management skills with a keen attention to detail required
Ability to exercise a high level of professionalism and discretion with respect to confidential and sensitive matters required
Ability to quickly and thoughtfully build and maintain relationships required
Ability to work both collaboratively and independently and meet deadlines required

Job Responsibility

Manages the calendar for the CCO
Makes scheduling decisions based on knowledge of priorities
Anticipates needs and obtains background materials for decisions, conferences, and meetings
Independently compiles, edits, reviews and disseminates relevant materials
Develops, reviews, and disseminates presentation materials for use during meetings
Conducts fact-finding and composes responses to non-routine inquiries
Manages, tracks, triages and/or directly respond to the daily flow of incoming and outgoing requests and correspondence
Responsible for review, prioritization, and triage of internal and external correspondence, communication and inquiries
Assists with proofing and finalizing presentations, letters and committee minutes
Corresponds on behalf of the office with Medical Center leaders and external organizations

Fulltime

New

Senior Field Reimbursement Specialist

Under general supervision of a Senior Manager, the Sr Field Reimbursement Specia...

Location

United States , Remote

Salary:

100700.00 - 155100.00 USD / Year

Cencora

Expiration Date

Until further notice

Requirements

Experience related and progressively responsible in a medical practice, private or third-party reimbursement arena, or pharmaceutical industry in sales, managed care, or clinical support
Experience within healthcare provider support such as a physician practice, patient assistance program or similar pharmaceutical/biological support program experience preferred
Bachelor’s degree preferred
Minimum of 7 years of experience
Candidates must possess a Prior Authorization Certification Specialist (PACS) credentials from an industry approved licensing body, or obtain certification within the first six months of employment
Ability to effectively manage multiple client relationships and customer
Ability to manage and support external meetings, presentations, and client interactions
Ability to lead and work in a matrix environment
Proven teamwork and collaboration skills with a demonstrated record of accomplishment of working in highly matrixed and cross-functional organizations
Ability to manage multiple tasks, timelines, expenses, and other activities necessary to fulfill the roles and responsibilities of a Field Reimbursement Specialists

Job Responsibility

Plan and engage with customers, leveraging client approved resources, to educate on access and reimbursement topics relevant to assigned client’s product
Track progress and evaluate results of assigned activities
Recommends changes in procedures
Lead or direct more complex projects or certain aspects of projects
Operates with reasonable latitude for un-reviewed action or decision
Work within a matrix environment to collaborate with internal and external stakeholders to secure optimized patient access and provide appropriate education through a focused effort on healthcare providers in community, institutional, and academic medical settings
Manage daily activities that support appropriate patient access to our client’s products in the provider offices and healthcare institutions, working as a liaison to other patient assistance and reimbursement support services offered by our clients
Review patient insurance benefit options with appropriate authorizations
Validate prior authorization requirements
Understanding of Specialty Pharmacy processes

What we offer

medical
dental
vision care
comprehensive suite of benefits that focus on the physical, emotional, financial, and social aspects of wellness
support for working families
backup dependent care
adoption assistance
infertility coverage
family building support
behavioral health solutions

Fulltime

Medical Reimbursement Representative

CVS Health

Location:
United States , Work at Home, Arizona

Category:
Customer Service

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
February 25, 2026

Expiration:
March 13, 2026

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Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:February 25, 2026

Expiration:March 13, 2026

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Job Posted:
February 25, 2026

Expiration:
March 13, 2026