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 12:30 – 9:00 PM PT. and every third Saturday, with rotating holidays.
The hours for this role are for a second shift based on the Pacific Time Zone.
*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.
– At least 6 months of experience in a role with increasing responsibility
– Beginner to moderate computer skills
– Pharmacy technician certification/experience
– Pharmacy, Managed Care, Medicaid, and/or Medicare
– Medical/Billing experience
High School Diploma or GED equivalent is required.