Senior Medical Collections Representative

Job DescriptionAs an Accounts Receivable Specialist, the candidate will work in a pharmacy operation setting at our Patient Financial Service Centers, supporting the claims follow up, denial and appeals processes. The candidate will work out of a unbilled queue and aged work list queue processing denials, unpaid claims, primary and secondary billing efforts for both commercial and government payers.The candidate will follow up on payment denials and underpayments on patients accounts, working with payers to ensure that all claims have been processed correctly and have been applied to the appropriate accounts. The candidate will continually monitor the billing and collections process to ensure that any communication, collection efforts and adjustments have been documented and recorded on patient accounts. Candidates directly impact a patient's life by ensuring all payer payments have been appropriately allocated, helping to alleviate the financial burden to patients. Health insurance billing and collections background and knowledge of medical and pharmacy terminology required.Required Qualifications3 + years of experience of the following:- Billing experience in pharmacy and/or medical coding and billing with full understanding of Pharmacy, Medical and Pharmacy DME claims.- Medical and/ or Pharmacy Collections and Reimbursement/ Accounts Receivable experience - Healthcare Insurance claims collections experience2+ years of experience in MS Office specifically MS ExcelCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues 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, religious belief, or other legally recognized reasons that prevents them from being 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 or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred QualificationsPaper (Universal Claim Forms and HCFA 1500) and Electronic Billing (System Adjudication and Web portal billing)- Analyzing EOBs and Remittance advice. Fully understand claims processing information.- Perform detailed research of claims and outstanding balances. Identifying root cause and resolve trends and issues with minimal supervision- Be able to work with a highly accountable team in a fast paced environment and quickly learn complex computer applications.- Communicate effectively and uphold excellent customer service and demeanor in challenging situations and escalated calls- Must have strong analytical, organizational, communication, and interpersonal skills.- Must also have excellent research, analytical and problem resolution skills.- Strong mathematical skill and understanding of account ledger- debits and credits- Proficient computer skills required to include experience with Microsoft and Windows based applications (Outlook, Excel, Word, Teams and SharePoint)

EducationVerifiable High School Diploma or equivalent.Business OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.