Senior Lead Coordinator, Revenue Cycle

CVS Health•Monroeville, PA

1d•$19 - $35•Onsite

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. Position Summary As the Senior Lead Coordinator you will be responsible for implementing and maintaining comprehensive billing review processes. You will identify and quantify trends/issues and effectively communicate/report them to the appropriate members of the management team and payer business partners along with the potential impact. You will assist leadership in building and maintaining a high performing highly engaged team. In this role you will also provide excellent mentorship and support to your colleagues as well as design and implement training classes. The key responsibilities of the Medical Revenue Cycle Senior Lead Coordinator are: Review and analyze patient profiles, benefits, and prior authorizations to identify potential issues affecting clean claims. Collaborate with clinical and administrative teams to ensure accurate documentation is maintained and available for claims processing. Monitor claims submissions and follow up on pending claims to expedite resolution and payment. Identify trends in claims denials and develop strategies for improvement. Conduct training sessions for staff on best practices for claims submissions and compliance. Maintain up-to-date knowledge of insurance policies, regulations, and healthcare trends that impact claims processing. Prepare reports on claims performance metrics and communicate findings to leadership. Act as a liaison between our organization and payers to resolve complex claims issues. Provide guidance and support to coordinators and staff members, fostering a culture of teamwork and excellence. Ensure compliance with all regulatory requirements and organizational policies related to claims processing and patient data management. Analyzes current workflows to identify bottlenecks or inefficiencies, and implements strategies to streamline processes, reduce errors, and enhance revenue cycle outcomes. Collaborates with stakeholders to implement new billing and coding technology, develop standardized procedures, and train staff on best practices. Coordinates with external stakeholders such as insurance companies, vendors, and patients, to resolve and/or clarify billing and reimbursement issues. Coordinates the implementation of internal controls and billing procedures to ensure the integrity and accuracy of reconciliation activities. Join forces with Payers, Payer Business Partners, Sales, Internal Department to secure needed documentation required to complete billing Ensure documentation aligns with the request and validate its accuracy and timely submission Performing detailed review and analysis of unbilled claims including but not limited to benefits and eligibility verification and prior authorization review prior to confirm accuracy prior to billing

Requirements

2+ years experience in medical benefit insurance verification
18+ months of experience as a Medical Billing or Collections Specialist
High level of proficiency with Excel.
Excellent communication, organizational, problem solving and interpersonal skills.
Extreme accuracy and attention to detail and data standards.
Must live within a 1 hour commute to the Monroeville office.

Nice To Haves

Ability to work in team and coordinate work efforts.
Experience with A/R reporting including trending, aging, etc.
Proficient in all Revenue Cycle systems
Experience using One Note

Responsibilities

Review and analyze patient profiles, benefits, and prior authorizations to identify potential issues affecting clean claims.
Collaborate with clinical and administrative teams to ensure accurate documentation is maintained and available for claims processing.
Monitor claims submissions and follow up on pending claims to expedite resolution and payment.
Identify trends in claims denials and develop strategies for improvement.
Conduct training sessions for staff on best practices for claims submissions and compliance.
Maintain up-to-date knowledge of insurance policies, regulations, and healthcare trends that impact claims processing.
Prepare reports on claims performance metrics and communicate findings to leadership.
Act as a liaison between our organization and payers to resolve complex claims issues.
Provide guidance and support to coordinators and staff members, fostering a culture of teamwork and excellence.
Ensure compliance with all regulatory requirements and organizational policies related to claims processing and patient data management.
Analyzes current workflows to identify bottlenecks or inefficiencies, and implements strategies to streamline processes, reduce errors, and enhance revenue cycle outcomes.
Collaborates with stakeholders to implement new billing and coding technology, develop standardized procedures, and train staff on best practices.
Coordinates with external stakeholders such as insurance companies, vendors, and patients, to resolve and/or clarify billing and reimbursement issues.
Coordinates the implementation of internal controls and billing procedures to ensure the integrity and accuracy of reconciliation activities.
Join forces with Payers, Payer Business Partners, Sales, Internal Department to secure needed documentation required to complete billing
Ensure documentation aligns with the request and validate its accuracy and timely submission
Performing detailed review and analysis of unbilled claims including but not limited to benefits and eligibility verification and prior authorization review prior to confirm accuracy prior to billing