[Hiring] Medical Billing & Accounts Receivable Representative @CVS Health

Role Description

CVS Health Specialty Pharmacy has an opportunity available for a full-time Medical Billing & Accounts Receivable Representative. As a Medical Billing & Accounts Receivable Representative, you will ensure timely and accurate billing and follow-up for outstanding claims while demonstrating excellent customer service to patients, healthcare professionals, and insurance carriers. As part of the billing and reimbursement team, you will work in a fast-paced and team-focused environment to ensure timely and accurate billing to insurance providers.

The key responsibilities of the Medical Billing & Accounts Receivable Representative are:

• Creating and submitting medical claims to insurance companies within timely filing and ensuring accuracy within payer guidelines and preferred bill methods (i.e., 837, website, spreadsheets, and CMS-1500).
• Validating coverage and eligibility prior to claim billing.
• Resolving insurance problems and patient issues that may have resulted from incorrect or incomplete information, therapy changes, and pharmacy or shipping errors.
• Maintaining supporting and chronological notes that detail action taken to resolve billing edits.
• Maintaining updated information within the necessary AR/CVS systems that are in accordance with company policy, following compliance regulations.
• Being an effective communicator with patients, providers, and insurance agents to resolve account issues.
• Researching information on provider portals.
• Ensuring that payer guidelines are being met.
• Spotting inaccuracies or inconsistencies in medical documentation and ensuring precision.
• Following up on unpaid claims and initiating appeals for denied ones within standard payer guidelines.
• Resolving issues with nonpayment of invoices due to insurance problems that may have resulted from incorrect or incomplete information, therapy changes, and pharmacy or shipping errors.
• Researching and responding by telephone, via the internet, and in writing to insurance companies and governmental payers regarding collection issues and problems.
• Contacting patients, physician’s offices, government agencies, and insurance companies for claim resolution.
• Contacting patients, physician’s offices, or payer entities to secure necessary documentation required for claim reimbursement.

Qualifications

• 1+ years Healthcare Insurance experience.
• Experience using Microsoft Office products specifically Excel, Outlook, and Word.
• Bilingual in English and Spanish, with the fluent ability to communicate effectively in both written and verbal formats.

Requirements

• Insurance billing or collections experience.
• Customer service in a healthcare and team environment.
• Attention to detail.
• Ability to multitask and meet deadlines.
• Ability to utilize problem-solving skills.
• Ability to communicate with clientele in a professional manner.

Benefits

• Comprehensive medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs.
• Other resources, based on eligibility.

Company Description

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.