CVS Health is launching a new Virtual Healthcare Practice that will include Virtual Primary Care services, Behavioral Health Virtual Care services, and General Medical Virtual care services.
The Accounts Receivable Coordinator will be responsible for managing all AR related to this line of business which will include;
- Manage front end claim edits through various reporting options to make claim corrections with the intent of submitting a claim to a payer for adjudication, while adhering to all payer guidelines and government regulations.
- Manage denials received from payers through various reporting with the intent to make corrections and submit appeals or corrected claims, contact payers to resolve the denial if applicable, and ensure claim resolution while adhering to all payer guidelines and government regulations.
- Manage the provider entry into the billing system based on credentialing status, and ensure the payer enrollment is set up and aligned with the provider enrollment participation status per payer
- You will also be responsible for all the AR associated with the payer and provider enrollment work which will include both front end claim edits to manage when claims can be billed as well as denials related to the enrollment status from a payer.
- You will provide representation when needed of the Accounts Receivable area to internal dept.’s as ell as external dept.’s, clients, vendors and processors to clearly relay situational occurrences and provide support when needed
- The account receivable associate will be 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
- 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
The specialist must have a clear understanding of the intricacies of medical billing encountered in such areas like ambulatory care, physician/provider offices, or professional billing settings. In addition, a clear understanding of CPT, ICD-9/10, CMS 1500 claim formatting, as well as, familiarity with Electronic Data Interchange (EDI) transmission, Electronic Health Record or encounter charge creation is key to success in this position. Knowledge of national HIPPA, PHI, and other regulatory requirements to help ensure compliance when working claims data is important.
The typical pay range for this role is:
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Minimum of 3 years of Medical Billing Experience or health plan claims adjudication experience
5 Years of Medical Billing experience or health plan claims adjudication experience
Experience working with Virtual Care professional
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
Epic registration and professional billing experience
Verifiable High School Diploma or GED required
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