Claim Field Analyst (Tampa, Florida)

CVS Health

10d • Hybrid

About The Position

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary The Claim Field Analyst acts as the primary resource for groups and providers, within a specific geographic location, to establish, oversee, and maintain a proactive claim education program focused on assisting providers with claim denials, claim education, and claim resolution. This person analyzes claim denials to track and trend potential opportunities, in order to assist in training and education of participating and non-participating providers. Additionally, they will assist in creating bulletins, newsletters, and claim trainings to improve provider claims issues. as well as billing practices, while collaborating with internal and/or external departments to identify claim training and education opportunities. This person will develop, implement, support, and promote provider training strategies, tactics, policies, and programs that drive provider satisfaction specific to claim submission and payments. The Claim Field Analyst works with the grievance and appeal and claims operations department to trend provider claim issues or concerns that could be prevented with additional provider claim education. They also work with the provider engagement team to collaborate on provider education when additional detailed claim education is needed. The Claim Field Analyst meets regularly, both in person and virtually, with assigned providers to conduct trainings and educations, review claim trends, and ensure understanding of Aetna Medicaid claim and billing policies and procedures. This person is expected to spend 70% of their time meeting with providers in-person, as well as conducting occasional telephonic or virtual provider meetings as needed. The Claim Field Analyst responds to assigned provider claim questions or inquires, and if necessary, ensures prompt resolution to provider issues with appropriate enterprise business teams. Other duties as assigned.

Requirements

• 3+ years of experience in medical billing and coding, specifically related to claims processing and root cause analysis.
• 3+ years of experience with provider engagement/relations.
• Working proficiency of Microsoft Office products (Word, Excel, PowerPoint, Outlook).
• Advanced experience in Microsoft Excel for data mining.
• Must reside in Central Florida - Tampa (Region D - Hardee, Highlands, Hillsborough, Manatee, Polk) and/or Orlando (Region E - Brevard, Orange, Osceola, Seminole) .
• Ability to travel 70% of time within Central Florida and will work remotely the remaining 30% of the time.
• Ability to work Monday-Friday from 8am-5pm EST, with the flexibility to work beyond core hours as needed.

Nice To Haves

• Excellent verbal and written communication skills.
• Regular and reliable attendance.
• Associate’s or Bachelor’s degree.
• Certified Professional Coder (CPC) certification.

Responsibilities

• Acts as the primary resource for groups and providers, within a specific geographic location, to establish, oversee, and maintain a proactive claim education program focused on assisting providers with claim denials, claim education, and claim resolution.
• Analyzes claim denials to track and trend potential opportunities, in order to assist in training and education of participating and non-participating providers.
• Assists in creating bulletins, newsletters, and claim trainings to improve provider claims issues as well as billing practices, while collaborating with internal and/or external departments to identify claim training and education opportunities.
• Develop, implement, support, and promote provider training strategies, tactics, policies, and programs that drive provider satisfaction specific to claim submission and payments.
• Works with the grievance and appeal and claims operations department to trend provider claim issues or concerns that could be prevented with additional provider claim education.
• Works with the provider engagement team to collaborate on provider education when additional detailed claim education is needed.
• Meets regularly, both in person and virtually, with assigned providers to conduct trainings and educations, review claim trends, and ensure understanding of Aetna Medicaid claim and billing policies and procedures.
• Responds to assigned provider claim questions or inquires, and if necessary, ensures prompt resolution to provider issues with appropriate enterprise business teams.
• Other duties as assigned.

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
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees