As the Pharmacy Billing Adjudicator for our Long Term Care business, you will be responsible for preparing and submitting claims for accounts. You will work directly with nursing facility staff, physician offices, and insurance companies to ensure timely payment of online claim submissions. You will also be responsible for reviewing and researching rejected third party claims, and problem solving to take appropriate action to resolve them.
Additional key responsibilities include:
- Working a backlog of rejected claims for timely resubmission
- Managing your assigned queues to keep current on all claims
- Clearing the workflow grid daily in order to meet productivity criteria
- Handling specific denials including new patient overrides
- Following applicable government regulations (i.e. HIPAA)
To be successful in the role, we are seeking candidates who display the core values of CVS: Collaboration, Integrity, Caring, Innovation, and Accountability.
You must be able to multi-task effectively, while working independently and as part of a team.
You must be able to work a late shift schedule Monday- Friday 10:30pm - 7am with rotating weekends/holidays
1 year pharmacy technician experience (Long Term Care or Retail Pharmacy preferred) in a role with increasing responsibility and requiring the use of a computer, including beginner-moderate familiarity with Microsoft Excel and Word
- Pharmacy Technician Certification/experience is highly preferred
- Pharmacy, Managed Care, Medicaid, and/or Medicare industry experience is preferred
High school diploma or equivalent
It's a new day in health care.
Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation's premier health innovation company. Through our health services, insurance plans and community pharmacists, we're pioneering a bold new approach to total health. As a CVS Health colleague, you'll be at the center of it all.
We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.
CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran – we highly value and are committed to all forms of diversity in the workplace. 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. 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. We provide reasonable accommodations to qualified individuals with disabilities. If you require assistance to apply for this job, please contact our Advice and Counsel Reasonable Accommodations team. Please note that we only accept applications for employment via this site.
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