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Position Summary

CVS Health, Specialty Pharmacy, a mail service pharmacy in the Orlando area, has an opportunity available for a full time Senior Billing Representative the candidate 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 an unbilled queue and aged worklist queue processing denials, unpaid claims, primary and secondary billing efforts for both commercial and government payers.

The candidate will 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. The candidate will continually monitor the billing and collections process to ensure that any communication, collection efforts and adjustments have been documented and recorded on patient accounts. Candidates directly impact a patient's life by ensuring all payer payments have been appropriately allocated, helping to alleviate the financial burden to patients. Health insurance billing and collections background and knowledge of medical and pharmacy terminology required.

Role Overview

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

What you will do

• Responsible for all third party follow-up associated with the dispensing of prescription medication; maintain supporting chronological notes that detail action taken to resolve outstanding account balances.
• Maintains patient demographic information and data collection systems.
• Work all billing/collection reports, queues, or diversions according to payer and company policy guidelines.
• Work in a fast paced and team focused environment to ensure timely and accurate billing to insurance providers.
• Transmit or submit paper and/or electronic claims to insurance payors for reimbursement, research and respond to insurance companies and governmental payors regarding billing issues or related questions by telephone, via the internet, and in writing.

Required Qualifications

• Must live within a 1 hour commute to the Orlando, FL office.
• 1+ years of experience of the following:
• Billing experience in pharmacy and/or medical coding and billing with full understanding of Pharmacy, Medical and Pharmacy DME claims.
• Medical and/or Pharmacy Reimbursement/Accounts Receivable experience.
• Healthcare Insurance claims collections experience.
• Be able to understand and analyze EOBs and remittance advice breakdown; fully understand claims processing information.
• Experience in MS Office, specifically MS Excel.

Preferred Qualifications

• 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 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 MS 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:

$18.50 - $31.72

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: 08/27/2024

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