Pharmacy Billing Adjudicator
As the Pharmacy Billing Adjudicator for our Long Term Care business, you will be responsible for preparing and submitting claims for accounts. You will work directly with nursing facility staff, physician offices, and insurance companies to ensure timely payment of online claim submissions. You will also be responsible for reviewing and researching rejected third party claims, and problem solving to take appropriate action to resolve them.
Additional key responsibilities include:
- Working a backlog of rejected claims for timely resubmission
- Managing your assigned queues to keep current on all claims
- Clearing the workflow grid daily in order to meet productivity criteria
- Handling specific denials including new patient overrides
- Following applicable government regulations (i.e. HIPAA)
- Handling benefit information with the utmost accuracy and confidentiality
To be successful in the role, we are seeking candidates who display the core values of CVS Health: Collaboration, Integrity, Caring, Innovation, and Accountability. You will be able to multi-task effectively, while working independently and as part of a team. Impeccable communication skills will be key to this role, as you will be working with customers within our long term care community.
This role offers a comprehensive benefits package, including Medical, Dental, Vision, Flexible & Health Spending Accounts, paid Short Term Disability, and 401(k) with company match! In addition, you can expect up to 16 days of paid time off, 10 company paid holidays, and a colleague discount at our CVS Pharmacy stores!
You must be able to work a schedule of Monday through Friday from 1pm to 930pm Eastern Time, with rotating weekends and holidays, (must be flexible for possible changes in shift due to business needs.)
This is a work from home opportunity.
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.
6 months+ of experience in a role with increasing responsibility and requiring the use of a computer
-Pharmacy Technician Certification (highly preferred)
-Experience in Pharmacy, Managed Care, Medicaid and/or Medicare organizations is preferred
High School Diploma or GED equivalent is required
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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.