Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
 
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary

A Brief Overview
Oversees the day-to-day management and leadership of critical aspects of billing operations. Develops a team to manage billing and claims processing, insurance verification and authorization, revenue cycle management, compliance and documentation, as well as customer service and issue resolution. Creates processes to ensure efficient and accurate billing processes, compliance, and consistent customer service within the department.

What you will do

• Oversees the pre-authorization process, which involves reviewing and approving requests for medical procedures, treatments, tests, or services before they are performed.
• Ensures that pre-authorization requests are processed accurately and in a timely manner, adhering to established guidelines and protocols.
• Reviews and evaluates authorization requests, ensuring that they comply with the company's policies, procedures, and insurance requirements.
• Verifies the patient's insurance coverage and additional billing details to determine the specific requirements for obtaining authorization.
• Verifies that all authorization requests, documentation, and communication with insurance providers are properly recorded and maintained within appropriate systems.
• Tracks metrics such as turnaround time, approval rates, and denials, subsequently preparing reports to assess team performance, identify trends, and propose process improvements.
• Collaborates with healthcare providers, insurance companies, and internal departments to ensure positive member and provider experiences.
• Ensures that the company's authorization procedures align with legal and regulatory requirements, implementing changes or procedural modifications as necessary.
• Assigns tasks, sets performance goals, conducts performance evaluations, and provides training and educational development opportunities to team members.

 

Required Qualifications
3-5 years work experience

Preferred Qualifications
Prior Authorization Certified Specialist (PACS) perferred.

Education Post secondary /high school education or specialized training,  ie, technical/vocational programs 

Pay Range

The typical pay range for this role is:

$43,888.00 - $85,068.00

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

We anticipate the application window for this opening will close on: 11/19/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.