Insurance AR Resolution Analyst, Revenue Cycle

CVS Health•Island, KY

1d•$43,888 - $102,081•Remote

About The Position

CVS Health Third-Party Revenue Cycle Management (RCM), supporting CVS Retail pharmacies, has an opportunity for a full-time Insurance AR Resolution Analyst. As an RCM Analyst, you will perform advanced, payer-level analysis to support Third Party Account Management in maximizing collections, reducing bad debt, and ensuring compliance with federal, state, and CVS Health requirements. This role focuses on identifying systemic drivers of payer exceptions, overpayments, liabilities, and remittance issues through trend analysis, root cause diagnosis, and data validation. The analyst produces clear, leadership-ready insights and recommendations that drive short- and long-term operational improvements across Commercial and Medicaid payers. In addition to supporting the Pharmacy Account Management team, this analyst will coordinate files for write offs and will work closely with our system partners by attending requirement meetings, identify and report defects as well as follow up on the resolution, and recommend and write requests to streamline current processes. Success in this role requires analytical thinking, attention to detail, and the ability to follow established procedures while exercising judgement to escalate or recommend resolution paths as appropriate. As part of the account management team, you will work in a fast paced and team focused environment to ensure timely and accurate AR resolution. We will support you by offering the tools and resources you need to be successful in a collaborative environment.

Requirements

Knowledge of Third Party Revenue Cycle operations, payer behavior, and liability resolution.
Knowledge of Commercial and Medicaid payer environments.
Skill in advanced analytical and root cause diagnosis techniques.
Solid working knowledge of all MS Operating Systems and MS Office applications (MS Word, Excel, Access, PowerPoint), and process mapping software such as Microsoft Project and Visio.
SQL and data-mining tools to validate and reconcile financial data.
Familiarity with MicroStrategy, SQL, and other data mining tools.
Ability to develop leadership-ready documentation and recommendations.
Ability to independently evaluate complex problems and recommend effective solutions.
Ability to influence decisions through data-driven insights rather than authority.
Ability to prioritize and organize work to accurately complete projects or assignments on schedule.
Ability to work individually or with a team to systematically identify and define problems, evaluate alternatives and implement practical, cost-effective solutions.
Ability to frame recommendations and formally present them to management.
Ability to work with sensitive financial and patient data in compliance with HIPAA.
Ability to maintain composure and perform job duties/responsibilities when confronted with stressful situations.
Ability to maintain excellent verbal and written communication skills and the ability to interact professionally with a diverse group - directors, managers, colleagues, and external entities.
Ability to work in strict confidence, always ensuring the confidentiality of the patient and medical and financial records, in compliance with company and HIPAA Privacy guidelines.
Ability to operate effectively in ambiguous or evolving environments.
Prior Relevant Work Experience: 2+ years required.
High School Diploma or General Equivalent Development (GED).

Nice To Haves

Accounts receivable or payer-facing experience.
Experience supporting system enhancements or process improvement initiatives.
Strong presentation and stakeholder communication skills.
Bachelor Degree.
3 to 5 years of analytics experience.

Responsibilities

Perform advanced, payer-level analysis to support Third Party Account Management in maximizing collections, reducing bad debt, and ensuring compliance with federal, state, and CVS Health requirements.
Identify systemic drivers of payer exceptions, overpayments, liabilities, and remittance issues through trend analysis, root cause diagnosis, and data validation.
Produce clear, leadership-ready insights and recommendations that drive short- and long-term operational improvements across Commercial and Medicaid payers.
Coordinate files for write offs.
Work closely with system partners by attending requirement meetings, identify and report defects, follow up on resolution, and recommend and write requests to streamline current processes.
Apply advanced analytical and statistical techniques to identify root causes of Third-Party payer issues.
Validate data accuracy and completeness using SQL and internal reporting tools.
Translate complex findings into clear, actionable recommendations for leadership.
Collaborate cross-functionally to prevent recurrence of payer issues.
Maintain regular and predictable attendance and perform additional duties within role scope.