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Position Summary

Performs claim documentation review, verifies policy coverage, assesses claim validity, communicates with healthcare providers and policyholders, and ensures accurate and timely claims processing. Contributes to the efficient and accurate handling of medical claims for reimbursement through knowledge of medical coding and billing practices and effective communication skills.

A Brief Overview

Performs claim documentation review, verifies policy coverage, assesses claim validity, communicates with healthcare providers and policyholders, and ensures accurate and timely claims processing. Contributes to the efficient and accurate handling of medical claims for reimbursement through knowledge of medical coding and billing practices and effective communication skills. What you will do

· Receives and monitors the completeness and accuracy of claims forms and supporting documentation submitted by healthcare providers.

· Enters claim information, such as patient information, provider details, procedure codes, and diagnosis codes, into the company's claims processing system.

· Documents relevant information for the eligibility of the claim, determining coverage and benefits, and assessing the validity and medical necessity of the services rendered.

· Calculates claim payments based on the approved reimbursement rates, fee schedules, or contracted rates with healthcare providers.

· Communicates claim status updates to healthcare providers, policyholders, or other stakeholders to provide transparency and ensure any additional information is resolved quickly.

· Assists in resolving discrepancies or issues related to claims by researching and investigating claim-related inquiries, collaborating with internal teams or departments, and coordinating with healthcare providers to resolve claim processing errors or discrepancies.

· Provides customer service support by addressing inquiries and resolving issues related to claims processing.

· Ensures that all claims processing details and notes are inputted into the company systems database.

· Assists in data entry tasks related to claims data management, such as updating claim statuses, maintaining accurate records, or ensuring proper documentation of claims processing activities.

Required Qualifications

· 6 months work experience

· Working knowledge of problem solving and decision making skills

Preferred Qualifications

· Certified Billing and Coding Specialist (CBCS) preferred.

Education

High School Diploma or equivalent GED

Pay Range

The typical pay range for this role is:

$17.00 - $28.45

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

We anticipate the application window for this opening will close on: 05/31/2024

We are an equal opportunity and affirmative action employer. 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.