Pharmacy Benefit Credit and Refund Specialist Coordinator, Revenue Cycle (Hybrid)

CVS Health•Monroeville, PA

12d•$17 - $28•Hybrid

About The Position

CVS Health Specialty Pharmacy, a mail service pharmacy in the Monroeville area, is hiring a full-time Pharmacy Benefit Credit and Refund Specialist Coordinator to handle insurance credit balance follow-up. The role ensures timely and accurate resolution of credit balances with payers while providing excellent customer service to patients, healthcare professionals, and insurance carriers. The successful candidate will work in a fast-paced, team-focused, collaborative environment, with tools and resources provided to support success. This position performs insurance follow-up and revenue-cycle activities related to prescription dispensing and healthcare accounts receivable. It involves investigating and resolving credit balances, documenting actions, maintaining patient information, and communicating with payers, patients, and physician offices. The role is based at the Monroeville, Pennsylvania office and requires the ability to commute there.

Requirements

At least 1 year of healthcare insurance-related experience.
Experience using Microsoft Office products, specifically Excel, Outlook, and Word.
Ability to commute to the Monroeville, Pennsylvania office.
Verifiable high school diploma or GED.
Professional verbal and written communication skills.
Ability to navigate multiple tasks simultaneously and prioritize according to importance while maintaining strong attention to detail.

Nice To Haves

Insurance billing or collections experience.
Customer service experience in a healthcare environment.
Experience working in a healthcare reimbursement system.
Effective customer service skills and experience demonstrating the ability to work in a team environment.
Attention to detail.
Ability to utilize analytical skills.

Responsibilities

Follow up with third-party insurers regarding prescription medication dispensing by telephone, internet, and in writing.
Review and validate credit balances by verifying accurate billing and cash-posting procedures.
Resolve credit-balance issues, including identifying overpayments and validating appropriate revenue recognition.
Perform analytical activities for the revenue-cycle department managing healthcare accounts receivable.
Initiate refunds, reverse claims, request payer offsets, and post adjustment transactions.
Maintain chronological supporting notes detailing actions taken to resolve outstanding account balances.
Maintain patient demographic information and data collection systems.
Research and respond to insurance companies and governmental payers regarding collection issues and problems by telephone, internet, and in writing.
Contact patients, physician offices, and insurance companies as needed to validate claims processing and payments.