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Position Summary

CVS Health Specialty Pharmacy has an opportunity available for a full time Medical Billing Representative. This role will work in a pharmacy operation setting at our Patient Financial Service Centers, supporting the claims follow up, denial and appeals processes. The candidate will work out of a unbilled queue and aged work list queue processing denials, unpaid claims, primary and secondary billing efforts for both commercial and government payers. 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. Located in the Orlando Facility, this opportunity also provides free parking. We will support you by offering all the tools and resources you need to be successful in a collaborative team based environment.

Role Overview

• Schedule: Monday-Friday, 8:00AM-4:30PM EST
• Hybrid Role

What you will do

• Follow up on payment denials and underpayments on patient’s accounts, working with payers to ensure that all claims have been processed correctly and have been applied to the appropriate accounts.
• Monitor the billing and collections process to ensure that any communication, collection efforts and adjustments have been documented and recorded on patient accounts.
• Directly impact a patient's life by ensuring all payer payments have been appropriately allocated, helping to alleviate the financial burden to patients.

Required Qualifications

• 1 years of experience of billing experience in pharmacy and/or medical coding and billing with full understanding of Pharmacy, Medical and Pharmacy Durable Medical Equipment (DME) claims.
• Experience in Microsoft Office and basic MS Excel (create spreadsheets, use filters, pivot tables)
• Must live within a 1 hour commute to the Orlando office.

Preferred Qualifications

• Health insurance billing and collections background and knowledge of medical and pharmacy terminology required.
• Medical and/ or Pharmacy Reimbursement/ Accounts Receivable experience
• Healthcare Insurance claims collections experience
• Be able to understand and analyzing Explanation of Benefits (EOB) and Remittance advice breakdown.
• Fully understand claims processing information
• Paper (Universal Claim Forms and HCFA 1500) and Electronic Billing (System Adjudication and Web portal billing)
• Perform detailed research of claims and outstanding balances. Identifying root cause and resolve trends and issues with minimal supervision
• Be able to work with a highly accountable team in a fast paced environment and quickly learn complex computer applications.
• Communicate effectively and uphold excellent customer service and demeanor in challenging situations and escalated calls
• Must have strong analytical, organizational, communication, and interpersonal skills.
• Must also have excellent research, analytical and problem resolution skills.
• Strong mathematical skill and understanding of account ledger- debits and credits
• Proficient computer skills required to include experience with Microsoft and Windows based applications (Outlook, Excel, Word, Teams and SharePoint)

Education

• Verifiable High School Diploma or GED required.

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits