Job Description 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 and every other Saturday, with rotating Sundays and holidays. The hours for this role are for a second shift based on the Pacific Time Zone.
*This is a work from home opportunity.*
Required Qualifications - At least 6 months of experience in a role with increasing responsibility - Beginner to moderate computer skills
COVID Requirements COVID-19 Vaccination Requirement CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.
If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.
Preferred Qualifications - Pharmacy technician certification/experience - Pharmacy, Managed Care, Medicaid, and/or Medicare industry experience - Medical/Billing experience
Education High School Diploma or GED equivalent is required.
Business Overview At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited 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.
Now hiring in your community CVS Pharmacy’s 60,000 Pharmacy Technicians are the first point of contact for patients visiting our retail locations. As a CVS Health Pharmacy Technician you will use your knowledge and skill to help thousands of people get the medications they need to improve their health. To learn more about the different kinds of Pharmacy Technician roles, and other current openings, select from the dropdown below. We’re actively hiring pharmacy technicians to help administer COVID-19 vaccines and care for patients across the United States. Learn more at https://jobs.cvshealth.com/2020. About CVS Health At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status.