Claims Biller / Adjustment Specialist - Monroeville, PA (Hybrid) at CVS Health

Monroeville, Pennsylvania, United States

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Not SpecifiedCompensation

Entry Level & New Grad, Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, PharmacyIndustries

Requirements

1 year of Healthcare Insurance Billing or related experience
Experience using Microsoft Office products specifically Excel, Outlook and Word
Must live within a 1 hour commute from Monroeville, PA

Responsibilities

Third party insurance claim billing associated with the dispensing medication and using the bill method required by the payer
Transmit or submit claims (paper/electronic) to insurance payors for reimbursement
Resolve insurance problems and patient issues that may have resulted from incorrect or incomplete information, therapy changes and pharmacy or shipping errors
Maintain supporting and chronological notes that detail action taken to resolve billing edits
Maintain patient demographic and insurance information and data collections systems, including all billing reports, work queues, or diversions according to payer and company policy guidelines
Research and respond to insurance companies and governmental payors regarding billing issues or related questions by telephone, via the internet, and in writing
Contact patients, physician's offices or insurance carriers as needed in order to expedite billing claims
Process adjustments based information provided in work queues or requests submitted through other areas in the organization

Skills

insurance claim billing

third party billing

claim reconciliation

adjustment processing

electronic claims submission

payer reimbursement

insurance problem resolution

patient issue resolution

billing notes maintenance

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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