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.
Position Summary
Performs claim documentation review, verifies policy coverage, assesses claim validity, communicates with healthcare providers and policyholders, and ensures accurate and timely claims processing. Contributes to the efficient and accurate handling of medical claims for reimbursement through knowledge of medical coding and billing practices and effective communication skills.
A Brief Overview
Performs claim documentation review, verifies policy coverage, assesses claim validity, communicates with healthcare providers and policyholders, and ensures accurate and timely claims processing. Contributes to the efficient and accurate handling of medical claims for reimbursement through knowledge of medical coding and billing practices and effective communication skills.
What you will do
· Receives and monitors the completeness and accuracy of claims forms and supporting documentation submitted by healthcare providers.
· Enters claim information, such as patient information, provider details, procedure codes, and diagnosis codes, into the company’s claims processing system.
· Documents relevant information for the eligibility of the claim, determining coverage and benefits, and assessing the validity and medical necessity of the services rendered.
· Calculates claim payments based on the approved reimbursement rates, fee schedules, or contracted rates with healthcare providers.
· Communicates claim status updates to healthcare providers, policyholders, or other stakeholders to provide transparency and ensure any additional information is resolved quickly.
· Assists in resolving discrepancies or issues related to claims by researching and investigating claim-related inquiries, collaborating with internal teams or departments, and coordinating with healthcare providers to resolve claim processing errors or discrepancies.
· Provides customer service support by addressing inquiries and resolving issues related to claims processing.
· Ensures that all claims processing details and notes are inputted into the company systems database.
· Assists in data entry tasks related to claims data management, such as updating claim statuses, maintaining accurate records, or ensuring proper documentation of claims processing activities.
Required Qualifications
· 6 months work experience
· Working knowledge of problem solving and decision making skills
Preferred Qualifications
· Certified Billing and Coding Specialist (CBCS) preferred.
Education
High School Diploma or equivalent GED
Pay Range
The typical pay range for this role is:
$17.00 – $28.45
This 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
We anticipate the application window for this opening will close on: 05/22/2024
Concern Worldwide is an international humanitarian organization committed to ending extreme poverty, whatever it takes. Founded in Ireland in 1968, Concern Worldwide has nearly 4,000 personnel working in 26 countries across the globe. Concern believes in a world where no one lives in fear; where all have access to a decent standard of living and the opportunities essential to a long, healthy and creative life.
We believe in creating a culture of inclusion where everyone feels empowered to bring their full, authentic selves to the workplace. Building a diverse and inclusive team is an absolute necessity to deliver the solutions needed to achieve our core mission, because without promoting justice and equality, we cannot eliminate extreme poverty.
Concern Worldwide US (CUS) is an independent affiliate of Concern Worldwide, with offices in New York, Chicago, and Los Angeles. CUS advances the Concern Worldwide mission through mobilizing financial and human resources, as well as influencing and activating networks in the US to elevate programs globally.
Information about the position:
This is a contract position through December 2024, but has the potential to lead to a full-time position. The Digital Production Associate will assist the Marketing Technology Manager in email production and maintenance of Concern’s marketing technology platform.
Responsibilities:
Assist in the production of Concern Worldwide US emails
Set up and maintain tracking for web, social media, and email
Assist in the creation and set up of digital marketing campaigns
Sourcing data, formatting it, and inputting into the correct systems
Troubleshoot issues in email rendering and templates
Requirements
Intermediate HTML/CSS knowledge
Adobe Photoshop experience
Strong attention to detail
A highly motivated self-starter with the ability to work with minimal supervision
Flexibility to meeting changing deadlines and priorities and ability to manage multiple tasks
Commitment to the core values and vision of Concern Worldwide
Candidates must be currently authorized to work in the US
Availability during normal working hours in New York City (Eastern Time Zone)
Nice to Have:
Knowledge of email-specific coding conventions
Knowledge of Salesforce Account Engagement (Pardot) or similar marketing automation platform
Experience with Litmus
Compensation & Structure:
24-30 hours/week @ $25-30/hour, based on experience
As a Data Entry Agent, you will be joining our Data Enrichment team to support the data enrichment tasks for our clients. You’ll be held to a high quality of work standard and will be a contributor to the quality control process.
What will you do?
Responsible for reviewing and completing Enrichment Tasks as defined and trained by the client
Primary work will be application data entry, vendor resource verifications, board certifications, and following up with various state boards for statuses
Responsible for timely and quality execution of tasks
Why we think this job is great:
It’s a full-time, 100% remote position where you’ll work from home.
You’ll have clear goals and the training resources you need to deliver. How you execute and deliver is up to you.
Qualifications:
Excellent written and verbal communication skills.
Available 40 hours per week starting immediately
Experience in an outbound/inbound call center, inside sales experience, or related sales or customer service experience is a plus.
Adaptable and flexible, demonstrating abilities to work with process and information changes
Ability to work independently or as an active member of a team
NationsBenefits is recognized as one of the fastest-growing companies in America and a Healthcare Fintech provider of supplemental benefits, flex cards, and member engagement solutions. We partner with managed care organizations to provide innovative healthcare solutions that drive growth, improve outcomes, reduce costs, and bring value to their members.
Through our comprehensive suite of innovative supplemental benefits, fintech payment platforms, and member engagement solutions, we help health plans deliver high-quality benefits to their members that address the social determinants of health and improve member health outcomes and satisfaction.
Our compliance-focused infrastructure, proprietary technology systems, and premier service delivery model allow our health plan partners to deliver high-quality, value-based care to millions of members.
We offer a fulfilling work environment that attracts top talent and encourages all associates to contribute to delivering premier service to internal and external customers alike. Our goal is to transform the healthcare industry for the better! We provide career advancement opportunities from within the organization across multiple locations in the US, South America, and India.
Role:
A Quality Assurance Specialist will monitor and rate assigned program call performance to ensure the highest level of quality is achieved for client, center, and corporate.
Report daily, weekly, and monthly quality results. Report results to center and corporate management.
Recommend changes necessary to ensure quality performance.
Participate in scheduled internal remote monitoring sessions with clients. Provide quality result information on QA candidates for posted positions.
Work in conjunction with training to ensure QA participation with new programs, new hire classes on existing programs, and/or changes to programs.
Participate in review meetings including the development information on quality performance on assigned programs.
Participate in calibration sessions to ensure program compliance and balance on the program.
Ensure notification to appropriate personnel on quality equipment and software programs.
Coach agents on performance improvement.
Seek knowledge to improve individual skills and knowledge in delivering positive and constructive feedback.
Maintain positive, consistent and effective communication with agents, peers and superiors.
Maintain positive, consistent, and effective communication with management to ensure client goals and objectives are achieved.
Perform other duties based on business demands as assigned.
Qualifications:
High school diploma or equivalent
2+ years of call center customer service experience
1+ years of call center quality monitoring and coaching
Highly PC proficient
Attention to detail and quality-oriented
Multi-task oriented
Exposure and/or interest in healthcare products and outcomes
Ability to remain highly motivated in a fast-paced, multi-faceted environment
Analytical thinker and problem solver
Excellent listening and interpersonal skills
Confident, approachable, and positive attitude
Excellent oral and written communication skills
Demonstrates personal responsibility (i.e., attendance, punctuality, ownership of day-to-day activities)
Job Details Description Envision Radiology is looking for a Remote Full Time Refund Specialist to join our team! Open to AL, AZ, CO, FL, ID, LA, MO, NE, NC, OK, TX, UT, VA, WA & WI Markets Monday – Friday 8:00AM – 4:30PM MST | Position Pay Range $17.35 – $20.95
Summary/Objective
The Refund Specialist is responsible for reviewing patient accounts, identifying patient & insurance overpayments and credit balances. This position works closely with insurance companies and internal billers to reconcile correct payments received. Additionally, evaluates and verifies accounts in accordance with program provisions. This will include data entry, posting payments, reconciling billing & invoices, checking balances, maintaining patient files and requesting refunds.
Essential Functions
Identifies credit balances due to electronic or manual insurance overpayments, patient overpayments, and adjustments resulting from denials or contractual allowances. Investigates and resolves assigned credit balance accounts by ticketing system, credit balance tickler or emails. Corrects patient and insurance payments to patient accounts, calculates, enters and corrects contractual adjustments and patient discounts if needed. Issues patient and insurance refunds. Detects posting and payer trends and/or errors. Handles both internal and external phone calls regarding credit balances and refunds. Other duties as assigned. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
This position has no supervision responsibilities.
Work Environment
This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
While performing the duties of this job, the employee is regularly required to use hands and fingers to handle, feel or operate objects, tools or controls, and reach with hands and arms. The employee is frequently required to talk and hear.
Three plus years’ experience working with credit balances from electronic/manual EOBs, lockbox and patient payments or equivalent experience in patient accounting Three plus years’ experience in medical billing & refunding insurances and/or patients’ accounts or equivalent experience in patient accounting Detail oriented, self-motivated, a problem solver and a team player Ability to navigate multiple computer screens and browsers quickly and accurately Ability to excel in a very fast-pace team environment Ability to continuously “exceed” company and customer expectation Strong communication skills & professional demeanor Education / Certifications:
Minimum of High School diploma or equivalent (GED) Additional Eligibility Qualifications
None required for this position.
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Compliance
Adheres to Envisions Code of Conduct and Compliance Policies and attends annual Compliance training as set forth by the Company.
Company Benefits
Below is a list of benefits that are offered to employees, once eligibility is met.
Health Benefits: Medical/Dental/Vision/Life Insurance Company Matched 401k Plan Employee Stock Ownership Plan Paid Time Off + Paid Holidays Employee Assistance Program OSHA Exposure Rating: 1
It is reasonably anticipated NO employees in this job classification will have occupational exposure to blood and other potentially infectious body fluids.
Envision Radiology is an equal opportunity employer (M/F/D/V). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, veteran status, or any other basis protected by applicable federal, state or local law.
Applications accepted until 5/15/24
Qualifications Education Preferred High School or better in General Education.
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