Description
Bring your heart to CVS Health. Every 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. REQUIRED FOR THIS ROLE: *3+ years of ACAS (Automated Claim Adjudication Systems) Medical/Hospital Claim Processing experience.* *Position Summary* We have an exciting opportunity for a highly motivated candidate to join the rapidly growing Behavioral Health Payment Integrity and Customer Relations team that ensures Behavioral Health claims are paid correctly and focuses on reducing Behavioral Health member and provider abrasion. We are looking for a candidate who will serve as the lead for various claim and benefit reviews such as compliance and legal claim reviews, provider and member escalated complaints, network, and clinical requests for claim assistance. As a member of the high-performing Behavioral Health Team, you will work in a dynamic and fast-paced environment with tight deadlines and rapidly changing requirements and priorities. We require an individual with strong ownership and collaborative skills, who will contribute to the team by looking for opportunities to achieve individual and broader team goals, while exhibiting flexibility for changing business needs. You will be part of a team that is dedicated to advocating for members by improving timeliness and accuracy of Behavioral Health claim payments. *Responsibilities* * Maintain a specialized knowledge of Behavioral Health claim processing and policy impacts. * Support business partners in discussions specific to Behavioral Health claim handling. * Create claim testing scenario, perform testing in ACASPBTE and provide confirmation the system is functioning as expected. * Communicate with partnering business areas, such as clinical and network, regarding claim reviews impacting members and providers. * Lead regular project discussions/updates via conference call. * Ownership of ongoing monthly/quarterly proactive reviews based on business needs. * Process/reprocess claims or submit rework project requests for necessary claim remediation. * Research and respond to Behavioral Health claim questions from business partners. * Process Behavioral Health claims for escalated member/providers situations and known system gaps supported by claim processing in the department. * Comfortable working with members or providers to resolve escalated claim concerns via email or phone. * Advocate for members by improving timeliness and accuracy of Behavioral Health claim payments. * Ability to identify error trends through claim reviews and provide insight into possible solutions. * Support the ongoing technical improvement of Behavioral Health system claim processing. * Flexible schedule depending on business needs. This is a 100% remote position. Work from anywhere in the U.S. *Required Qualifications* * *3+ years of ACAS Medical/Hospital Claim Processing experience.* * Experience with Claims/Policies & Procedures. * Strong MS Excel skills and experience with large data files. * Effective communication (verbal and written) and collaboration skills. * Experience in conflict resolution. * Thorough and detailed knowledge of investigating, analyzing and effecting corrective action. * Ability to analyze data, translate it into meaningful information and draw conclusions. * Ability to work independently, and to prioritize and manage multiple assignments/priorities with little supervision. * Good teamwork and collaboration skills with a strong work ethic. *Preferred Qualifications* * Experience with ECHS/E2I, EPDB, SCM, CCI, ATV/MedCompass. * Knowledge of Aetna's Commercial Products. * HRP Medical/Hospital Claim Processing experience * Customer service experience *Education* High School Diploma *Pay Range* The typical pay range for this role is: $43,700.00 - $91,800.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit [jobs.CVSHealth.com/benefits](https://jobs.cvshealth.com/benefits) We anticipate the application window for this opening will close on: 04/30/2024
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