Analyst,Eligibility

CVS Health•Work At Home-Texas, TX

1d•Onsite

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 Establishes and maintains processes regarding billing and claims processing, insurance verification and authorization, revenue cycle management, compliance and documentation, as well as customer service and issue resolution. Reconciles and solves issues to ensure accurate billing, facilitate smooth revenue flow, maintain compliance, and provide satisfactory customer experiences.

Requirements

2+ years customer service or client-facing experience in a fast-paced environment.
Basic awareness of problem solving and decision making skills.
Microsoft Office working experience.

Nice To Haves

3+ years in eligibility or other relevant background.
Proficiency in processing accurate and timely Eligibility data.
Experience in EDI (Electronic Data Interchange).
Understanding of the PBM industry.
Experience in a healthcare client facing role.
Experience in a fast-paced environment.
Knowledge of ANSI X12 834 Data Documents.
Familiarity with RxClaim and/or AS400.
Microsoft Excel experience.

Responsibilities

Reviews and analyzes applications, forms, and supporting documentation to verify individuals' eligibility for healthcare programs or insurance coverage.
Applies eligibility rules and regulations when evaluating information submitted by customers in support of initial or continuing eligibility determination.
Compiles and evaluates information, calculating eligibility factors, and ensuring consistent and fair eligibility determinations.
Escalates eligibility issues and updates member records in the appropriate database(s) to ensure accurate data.
Conducts basic quality audits of eligibility uploads to ensure data integrity is clean, accurate, and consistent with specifications.
Communicates regulations, rules, and policies to clients and apprises them of their rights, responsibilities, and eligibility for participation.
Educates customers on basic program services and eligibility requirements.
Coaches more junior colleagues in intellectual property techniques, processes, and responsibilities to help optimize eligibility reviews.
Assigns tasks, sets performance goals, conducts performance evaluations, and provides training and educational development opportunities to team members.