Medical Billing Representative

CVS Health is dedicated to bringing our heart to every moment of your health, driving our commitment to deliver enhanced human-centric health care. This guiding purpose shapes our approach to services, making sure how we deliver care is just as important as what we deliver. Our Heart At Work Behaviors™ empower our team to transform our culture, fostering innovation and personalizing healthcare delivery for a rapidly changing world.

Position Overview: CVS Health Specialty Pharmacy has an exciting full-time opportunity for a Medical Billing Representative in our Orlando facility. This role is integral to our pharmacy operations, specifically within our Patient Financial Service Centers, focusing on claims follow-up, denial management, and appeals processes. You will handle both commercial and government payer claims, ensuring timely and accurate billing in a collaborative, fast-paced environment. The role offers free parking and all necessary tools and resources for success.

Key Responsibilities:

• Claims Management: Follow up on payment denials and underpayments, ensuring correct processing and appropriate allocation to patient accounts.
• Documentation: Monitor billing and collections processes, ensuring that all communications, collection efforts, and adjustments are accurately documented.
• Patient Impact: Directly support patients by ensuring proper allocation of payer payments, helping to ease their financial burdens.

Required Qualifications:

• Experience: 1+ years of experience in pharmacy or medical coding and billing, with a comprehensive understanding of Pharmacy, Medical, and Durable Medical Equipment (DME) claims.
• Technical Skills: Proficiency in Microsoft Office, particularly basic MS Excel functions such as creating spreadsheets, using filters, and working with pivot tables.
• Location: Must live within a 1-hour commute to the Orlando office.

Preferred Qualifications:

• Health Insurance Knowledge: Background in health insurance billing and collections, with knowledge of medical and pharmacy terminology.
• Accounts Receivable: Experience in medical or pharmacy reimbursement and accounts receivable.
• Claims Processing: Ability to understand and analyze Explanation of Benefits (EOB) and Remittance Advice breakdowns.
• Billing Expertise: Proficiency in paper and electronic billing, including Universal Claim Forms, HCFA 1500, system adjudication, and web portal billing.
• Research and Problem Solving: Strong research skills to identify root causes and resolve trends with minimal supervision.
• Teamwork: Ability to work effectively in a high-accountability, fast-paced environment.
• Communication Skills: Excellent communication and customer service skills, particularly in challenging situations.
• Analytical Skills: Strong mathematical abilities and understanding of account ledgers, debits, and credits.
• Computer Skills: Proficiency with Microsoft and Windows-based applications, including Outlook, Excel, Word, Teams, and SharePoint.

Education:

• Verifiable High School Diploma or GED required.

Compensation & Benefits:

• Pay Range: $17.00 - $25.65 per hour. The actual salary will depend on experience, education, location, and other relevant factors. This position is also eligible for bonuses, commissions, or short-term incentives.
• Benefits: CVS Health offers a comprehensive benefits package, including medical, dental, and vision insurance, 401(k) retirement savings plan, employee stock purchase plan, life insurance, short-term and long-term disability benefits, well-being programs, education assistance, CVS store discount, and partner discounts.
• Time Off: Paid Time Off (PTO), vacation pay, and paid holidays in accordance with state law and company policies.