Medicare Part B Operations Coordinator, Revenue Cycle

CVS Health•Island, KY

6d•$17 - $34

About The Position

The Medicare Part B Operations Coordinator is responsible for supporting end to end Medicare Part B claims processing activities. This role helps ensure compliance with Centers for Medicare and Medicaid Services (CMS) requirements by facilitating accurate claim processing and submission, including manual intervention through prescriber outreach and documentation review. This function supports the Revenue Cycle Team’s objective of timely and accurate billing of pharmacy and medical claims to third party insurers. As a Medicare Part B Operations Coordinator, you will support the Revenue Cycle Medicare Part B Team in efforts to reduce bad debt, mitigate legal risk and ensure compliance with all federal, state, and CVS Health requirements. In this role, you will assist with initiatives to collect and validate prescriber documentation in accordance with CMS guidelines. Documentation collection will be conducted through prescriber outreach via fax and phone. You will be responsible for maintaining and managing a centralized repository of prescriber documentation and leveraging this data to identify actionable claim volume in alignment with established Standard Operating Procedures.

Requirements

1+ years of experience in retail pharmacy, PBM, or account management.
1+ years of professional MS Excel and Access experience.
Strong organizational and diagnostic skills with attention to detail, accuracy and follow through.
Demonstrated ability to communicate clearly, accurately and professionally across verbal, written, and phone interactions with internal and external stakeholders.
Verifiable High School Diploma or GED required.

Nice To Haves

Experience with Medicare Part B documentation verification, billing and/or collections.
Ability to make sound business decisions independently and collaboratively.
Ability to work effectively both independently and within a team.
Flexibility to adapt in a dynamic environment.
Strong organizational skills with attention to detail, accuracy and follow through.
Ability to maintain strict confidentiality in compliance with company standards and HIPAA guidelines.
Rhode Island Pharmacy Technician License (Tech II).
CPhT Certification by PTCB.
Associate’s Degree preferred.

Responsibilities

Support end to end Medicare Part B claims processing activities.
Ensure compliance with Centers for Medicare and Medicaid Services (CMS) requirements.
Facilitate accurate claim processing and submission.
Perform manual intervention through prescriber outreach and documentation review.
Support the Revenue Cycle Team’s objective of timely and accurate billing of pharmacy and medical claims to third party insurers.
Assist with initiatives to collect and validate prescriber documentation in accordance with CMS guidelines.
Conduct prescriber outreach via fax and phone.
Maintain and manage a centralized repository of prescriber documentation.
Leverage prescriber documentation data to identify actionable claim volume in alignment with established Standard Operating Procedures.