Analyst, Revenue Cycle(CPB or CPC preferred))

CVS Health

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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. The Revenue Cycle Associate will be involved in the company's day-to-day revenue cycle management and accounts receivable operations to ensure timely and appropriate submission of health care claims and subsequent payment for services rendered.

Requirements

• The ideal candidate must have experience in health care accounts receivable follow-up, a good understanding of the claims revenue cycle, and EPIC experience
• Must know how to read and interpret insurance Explanation of Benefits (EOB) statements
• At least 2 years of working on coding denials, and understanding of NCCI edits is preferred
• Solid understanding of insurance guidelines and principles including; COB, HIPAA, CPT, ICD-10, medical terminology, and managed care plans
• Time management skills, and the ability to meet deadlines is imperative
• education minimum of Associates degree, Bachelors preferred
• excel/google sheets experienced preferred
• US work authorization
• Someone who embodies being "Oaky"

Nice To Haves

• CPB and /or CPC credentials are a plus

Responsibilities

• Ensure payments are collected timely and in full from payers, and perform appropriate accounts receivable follow-up for denied claims
• Make use of all available tools (websites, electronic medical records, and payer systems) to efficiently identify reasons for non-payments, and follow the necessary steps for the insurance company to adjudicate the claims
• Work with insurance companies to follow up on denials of claims, make necessary corrections, and refile the claim to payer for reimbursement
• Process and upload checks/electronic payments for cash posting
• Review/approve patient statements prior to mailing
• Analyze data to identify trends and create reports for management
• Interact and collaborate with administrative staff within our clinics and our billing vendor to resolve billing questions
• Proficiency reading proper insurance plan and policy# from insurance ID cards
• Experience using Multi-payer web portals
• Ability to extract details from medical records to substantiate billing coding changes
• Communicate effectively using helpdesk ticketing system to reply to clinic inquiries regarding patient statements
• Contact payers to obtain clarification and/or details regarding incorrect payment/denials
• Effectively work edits within claim scrubbing software
• Accurately complete assignments in a timely manner
• Maintain working knowledge of company policies for collections, adjustments and write offs
• Possess strong critical thinking and problem solving skills to work through payers issues such as denials, underpayments and/or missing payment
• Adaptable to changing procedures and a growing environment
• Other duties as assigned

Benefits

• This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families.
• The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
• Additional details about available benefits are provided during the application process and on Benefits Moments.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree