Pharmacy Billing Adjudicator – CVS Health – Sanford, FL

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)
• Handling benefit information with the utmost accuracy and confidentiality

To be successful in the role, we are seeking candidates who display the core values of CVS Health: Collaboration, Integrity, Caring, Innovation, and Accountability. You will be able to multi-task effectively, while working independently and as part of a team. Impeccable communication skills will be key to this role, as you will be working with customers within our long term care community.

This role offers a comprehensive benefits package, including Medical, Dental, Vision, Flexible & Health Spending Accounts, paid Short Term Disability, and 401(k) with company match! In addition, you can expect up to 16 days of paid time off, 10 company paid holidays, and a colleague discount at our CVS Pharmacy stores!

You must be able to work a schedule of Monday through Friday from 3:00 pm to 11:30 pm Eastern Time, with rotating weekends and holidays, (must be flexible for possible changes in shift due to business needs.)

This is a work from home opportunity.

Required Qualifications

• 6 months+ of experience in a role with increasing responsibility and requiring the use of a computer
• Beginner-moderate familiarity with Microsoft Excel

Preferred Qualifications

• Pharmacy technician certification (highly preferred)
• Experience in pharmacy, managed care, Medicaid and/or Medicare organizations is preferred

Education
High School Diploma or GED equivalent is required

Business Overview
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. 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.