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Medical Collections Specialist

CVS | Monroeville, PA | 09/24/2021

Job Description
CVS Health, Specialty Pharmacy, a mail service pharmacy in the Monroeville area, has an opportunity available for a full time billing/insurance follow up representative. The primary responsibilities of a Medical Collections Specialist are to ensure timely and accurate account payment for outstanding balances while demonstrating excellent customer service to patients, healthcare professionals and insurance carriers.

Responsible for all third party follow-up associated with the dispensing of prescription medication; maintain supporting chronological notes that detail action taken to resolve outstanding account balances. Maintains patient demographic information and data collection systems. Work all billing/collection reports, queues, or diversions according to payer and company policy guidelines.

Researches and responds by telephone, via the Internet and in writing to insurance companies and governmental payors regarding billing issues and problems. Follows up on submitted claims; monitors unpaid claims, initiates appeals and resubmits claims as necessary. Easily identifies payor trends, prepares projects for escalations and all other duties as assigned to ensure timely and accurate reimbursement.

-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
-Provide detailed follow up with patients and payors in the form of, but not limited to phone calls, fax transmittals and e-mails
-Contact patients and Physician's offices as needed in order to expedite claims processing
-Obtain accurate demographic, insurance and financial information from patients to ensure all account information is accurate
-Located in the Monroeville Facility, this opportunity also provides free parking

Required Qualifications
- 1 + years' experience performing health care reimbursement, medical billing or insurance collections
- 1+ years' experience in Microsoft Office, specifically Excel, Outlook and Word

COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.
  • If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.


Preferred Qualifications
-1+ years of experience with collections associated with Medical billing or collections in health care
- Customer Service in a health care environment and with healthcare reimbursement
- Ability to communicate with clientele in a professional manner; both written and verbal
- Proven effective customer service skills and experience that shows ability to work independently and in a team environment
- Ability to navigate through multiple tasks simultaneously and prioritize based on importance while displaying strong attention to detail

Education
Verifiable High School Diploma or GED required

Business Overview
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

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October 26, 2021