Sr Representative, Billing

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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.
Position Summary
As a 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.
Required Qualifications
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
• Paper (Universal Claims Forms and HCFA 1500) and Electronic Billing (System Adjudication and Web portal billing)
• 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
CVS Health requires certain colleagues 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, religious belief, or other legally recognized reasons that prevents them from being 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 or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through ColleagueRelations@CVSHealth.com If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.