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
Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines.
– Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise.
– Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment. measures to assist in the claim adjudication process.
– Insures all compliance requirements are satisfied and all payments are made against company practices and procedures.
– Identifies and reports possible claim overpayments, underpayments and any other irregularities.
– Performs claim rework calculations.
– Makes outbound calls to obtain required information for claim or reconsideration.
Required Qualifications
Required 2+ years of Medical claims processing experience
Familiar with ICD and CPT coding
Ability to multitask while working independently
Preferred Qualifications
Required 2+ years of Medical claims processing experience
Familiar with ICD and CPT coding
Ability to multitask while working independently
Education
Request a minimum of an Associate’s degree which will be waived in lieu of medical claims processing experience.
Pay Range
The typical pay range for this role is:
$18.50 – $35.29
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.
