Medical Reimbursement Representative

CVS Health

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. As a Collector, you play an integral role in delivering cost effective solutions for our patients by working with insurance companies to resolve issues associated with our patients’ insurance claims. In this role you will ensure timely follow-up on all patient accounts; including escalating payer trending concerns to leadership and timely communication with external departments; work with payers to ensure proper reimbursement on patient accounts, identify and prepare adjustments and write-offs; correct and resubmit claims (subject to policy); follow-up on daily correspondence (denials, short-pays); interface with insurance companies via phone and web portal to check claim status, submit written correspondence to payers and patients; interpret contracts with payers to ensure proper payment; send initial or secondary bills to insurance companies; process refunds and work to overturn insurance claim rejections while maintaining quality and productivity requirements.

Requirements

1+ years of experience in a professional environment
1+ years experience working in Excel, Outlook, and Word

Nice To Haves

Home infusion or durable medical equipment (DME) experience
Strong attention to detail with a sense of urgency
Customer service skills
Ability to work in a team environment
Experience with medical billing or collections
Experience with accounts payable (AP) or accounts receivable (AR)
Experience with healthcare reimbursement systems

Responsibilities

Ensure timely follow-up on all patient accounts
Escalate payer trending concerns to leadership
Timely communication with external departments
Work with payers to ensure proper reimbursement on patient accounts
Identify and prepare adjustments and write-offs
Correct and resubmit claims (subject to policy)
Follow-up on daily correspondence (denials, short-pays)
Interface with insurance companies via phone and web portal to check claim status
Submit written correspondence to payers and patients
Interpret contracts with payers to ensure proper payment
Send initial or secondary bills to insurance companies
Process refunds
Work to overturn insurance claim rejections while maintaining quality and productivity requirements

Benefits

Instructor led training programs
Comprehensive benefits package that begins the first of the month after your start date
Medical insurance
Dental insurance
Vision insurance
Supplemental benefits
Retail discounts
Paid time off
Flexible work schedule
Retirement savings options
Wellness programs