Advanced Eligibility Consultant

CVS Health • East Lansing, ID

8d • Hybrid

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Advanced Eligibility Consultant is responsible for our most complex and highest valued clients. The Advanced Eligibility Consultant will also work and resolve complex issues. They translate direction and intent into actionable items while operating with minimal supervision. This person is consultative in nature when working with other departments, clients, and brokers. They coach and mentor junior staff, develop and execute training plans, coordinate and set daily objectives, identify and implement process improvements and efficiencies, and function as our highest level of escalation prior to manager/director involvement. The Advanced Eligibility Consultant will establish and maintain processes regarding billing and claims processing, insurance verification and authorization, revenue cycle management, and compliance & documentation, as well as customer service and issue resolution. They will reconcile and solve issues to ensure accurate billing, facilitate smooth revenue flow, maintain compliance, and provide satisfactory customer experiences.

Requirements

• 2+ years of experience with eligibility, particularly within the commercial health insurance industry, including a demonstrated proficiency in processing accurate and timely policy and eligibility data, ensuring services and products meet the plan sponsor needs.
• If local to East Lansing, MI or Plymouth, MN must have ability to work a hybrid schedule (3 days in the office per week).

Nice To Haves

• Experience using QuickBase.
• Proficiency in Microsoft Outlook, Teams, Windows, and Excel.
• Ability to manage multiple tasks/priorities.
• Adaptable and quick to grasp new concepts, with a solid foundation in auditing and a proven ability to think creatively and develop innovative solutions.
• Understands intent/end state and operates with minimal guidance to meet that intent/end state.
• Team player capable of operating independently when needed.
• Ability to provide accurate and timely results.
• Ability to delegate and follow up as needed.
• Ability to coach and mentor others.
• Experience as a Senior Eligibility Consultant and/or Senior Eligibility Analyst.

Responsibilities

• Establish and maintain processes regarding billing and claims processing, insurance verification and authorization, revenue cycle management, and compliance & documentation, as well as customer service and issue resolution.
• Reconcile and solve issues to ensure accurate billing
• Facilitate smooth revenue flow
• Maintain compliance
• Provide satisfactory customer experiences
• Coach and mentor junior staff
• Develop and execute training plans
• Coordinate and set daily objectives
• Identify and implement process improvements and efficiencies
• Function as our highest level of escalation prior to manager/director involvement

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level