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Job Title :
Senior Billing Specialist
Job ID :
Location :
RI - Cumberland
Street Address :
200 Highland Corporate Drive
Category :
Billing & Collections
Description :
Job Description
CVS Health/minute clinic is dedicated to helping people on their path to better health as part of the largest integrated pharmacy company in the United States. Through the company's more than 7,600 CVS/pharmacy stores; its leading pharmacy benefit manager serving more than 60 million plan members; and its retail health clinic system, the largest in the nation with more than 970 MinuteClinic locations, it is a market leader in mail order, retail and specialty pharmacy, retail clinics, and Medicare Part D Prescription Drug Plans. As a pharmacy innovation company with an unmatched breadth of capabilities, CVS Health continually strives to improve health and lower costs by developing new approaches.

The MinuteClinic Accounts Receivable Associate will be responsible for:

- Managing a high volume of medical claims that have denied by refuting the denials within payer guidelines through accurate review, correction, and resubmission.
- Provide representation when needed of the Accounts Receivable area to internal dept.’s as well as external dept.’s, clients, vendors and processors to clearly relay situational occurrences and provide support when needed.
- The account receivable associate will be responsible for identifying and quantifying trends/issues, developing potential solutions and then effectively communicate them to the appropriate members of the management team along with what the potential impact could be.
- Effectively prioritize and manage outstanding refund requests and overpayments to support contract and legal adherence with all payers including Medicare and Medicaid.
- Identify and implement process efficiencies across the dept. including automation opportunities or workflow enhancement opportunities to reduce manual efforts and improve productivity and overall compliance.
- Recognize and Identify coding deficiencies and exercise the appropriate action based upon compliance and CMS regulations.
- Identify key stake holders or primary contacts within payer communities to drive more effective processes.

The specialist must have a clear understanding of the intricacies of medical billing encountered in such areas like ambulatory care, physician/provider offices, or professional billing settings. In addition, a clear understanding of CPT, ICD-9/10, CMS 1500 claim formatting, as well as, familiarity with Electronic Data Interchange (EDI) transmission, Electronic Health Record or encounter charge creation is key to success in this position. Knowledge of national HIPPA, PHI, and other regulatory requirements to help ensure compliance when working claims data is important.

If this background describes you, you are interested in working for a fortune 10 healthcare organization, and have the ability to prioritize and manage multiple tasks at once we encourage you to apply.

Required Qualifications
- Minimum of 2 years of Medical Billing Experience or health plan claims adjudication experience.

Preferred Qualifications
- 3 or more years of Medical Billing experience or health plan claims adjudication experience
- Technical Certificate in Medical Billing
- Microsoft Office with a focus on Excel, Outlook, and Word
- Time management skills
- The ability to multi-task
- Athena Practice Management experience

- Verifiable High School Diploma or GED required.

Business Overview
MinuteClinic is the largest provider of retail health care in the nation and continues to be reaccredited by The Joint Commission. MinuteClinic’s unique structure and approach to health care offers a rewarding alternative to the traditional patient care practice, focused on autonomy, empowerment, education and evidence-based patient care. MinuteClinic operates the most retail clinics in the nation and is partnered with some of the largest health care systems in the country!

With MinuteClinic, you have the unique opportunity to manage your clinic and treat your own patients, in an autonomous environment, always knowing you have the support of your colleagues, managers and collaborating physicians, behind you. Led by our expert clinicians and guided by our evidenced based practices, MinuteClinic moves the treatment of common illnesses forward and provides the high-quality care you might expect from traditional patient care settings.

CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking EEO AA CVS Health

CVS Health does not require nor expect that applicants disclose their compensation history during the application, interview, and hiring process.

For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-338-5609. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. Please note that we only accept resumes via our corporate website:

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