Senior Claim Data Specialist, Provider Claims (Must reside in Florida)

CVS Health•Work At Home-Florida, FL

7d•$19 - $35•Remote

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.

Requirements

1-3 years of medical claims experience.
1-3 years of intermediate Excel experience, with demonstrated proficiency in formulas, pivot tables, and vlookups.
Must reside in Florida.

Nice To Haves

Bilingual in English/Spanish.
2+ years of provider claims experience.
Certified Professional Coder (CPC).
Knowledge of provider billing, particularly with professional and hospital claims.
Strong attention to detail.
Excellent communication, collaboration, and relationship building skills.
Self-motivated and ability to drive independent work.
Strong writing and documentation skills.

Responsibilities

Perform claims analysis related to disputes, legal matters, state complaints, provider inquiries, and internal team inquiries.
Determine whether any claim payment or denial issues are present, particularly those that may affect utilization management, enrollment, claims, configuration, network, contracting and/or provider data.
Submit the necessary documents (if issues are identified) to specific areas, in an effort to ensure all is updated and corrected.
Submit all projects and/or claims to be reprocessed, in order to ensure provider contracts are implemented effectively, as well as to avoid any further ongoing issues.
Perform education for providers, both internal and external, when required.
Attend provider group meetings, as well as individual meetings, both internally and externally.
Submit projects within Microsoft Excel as assigned.
Perform other duties as needed.