This list contains only the countries for which job offers have been published in the selected language (e.g., in the French version, only job offers written in French are displayed, and in the English version, only those in English).
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Job Responsibility:
Managing a high volume of medical claims that have denied by refuting the denials within payer guidelines through accurate review, correction, and resubmission
Provide representation when needed of the Accounts Receivable area to internal dept.’s as well as external dept.’s, clients, vendors and processors to clearly relay situational occurrences and provide support when needed
Responsible for identifying and quantifying trends/issues, developing potential solutions and then effectively communicate them to the appropriate members of the management team along with what the potential impact could be
Effectively prioritize and manage outstanding refund requests and overpayments to support contract and legal adherence with all payers including Medicare and Medicaid
Identify and implement process efficiencies across the dept. including automation opportunities or workflow enhancement opportunities to reduce manual efforts and improve productivity and overall compliance
Recognize and Identify coding deficiencies and exercise the appropriate action based upon compliance and CMS regulations
Identify key stake holders or primary contacts within payer communities to drive more effective processes
Requirements:
Clear understanding of the intricacies of medical billing encountered in such areas like ambulatory care, physician/provider offices, or professional billing settings
Clear understanding of CPT, ICD-9/10, CMS 1500 claim formatting
Familiarity with Electronic Data Interchange (EDI) transmission, Electronic Health Record or encounter charge creation
Knowledge of national HIPPA, PHI, and other regulatory requirements to help ensure compliance when working claims data
Minimum of 2 years of Medical Billing Experience or health plan claims adjudication experience
Verifiable High School Diploma or GED required
Nice to have:
3-5 Years of Medical Billing experience or health plan claims adjudication experience
Technical Certificate in Medical Billing
Microsoft Office with a focus on Excel, Outlook, and Word
Time management skills
The ability to multi-task
Athena Practice Management experience
What we offer:
Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching