Position Summary:Omnicare, Inc. is a wholly ownedsubsidiary of CVS Health Corporation. www.cvshealth.com
What We Do
Directly, and through oursubsidiaries, Omnicare provides a broad array of pharmacy-related services tolong term care facilities and to other customers in the health careenvironment. While senior care has long been an Omnicare specialty, we alsoserve other targeted populations.
Overview : Billing Specialist I will be responsible for qualifying, preparing and submitting claims to Medicare Part B and Medicaid. Individual must work with long term care facility staff, Omnicare pharmacy operations staff, prescriber offices, third party payers, patients and/or their responsible parties and claim processors. This position requires work within several different pharmacy dispensing systems and web based billing portals and software programs. Billers must obtain supporting clinical and non-clinical information to perform coverage criteria review. Billers must verify valid dispensing orders for all new and refill orders and work claims through to resolution to ensure compliant, timely and accurate billing.
Shift: M-F 10am-6:30pm
· Responsible for all Part B covered drug and Medicaid supply billing for Omnicare
· Manage assigned queues keeping up to date and current on all point of sale claims
· Review and research rejected third party claims taking appropriate actions to resolve
· Contact facility, beneficiary and/or prescribers to obtain all clinical and non-clinical information needed to perform coverage criteria review
· Verify preliminary dispensing orders are valid for all new and refill orders and that the information is accurate on the third party claim. Work with pharmacy or facility to correct errors or rectify issues prior to dispensing
· Assist other adjudication departments with coverage criteria review
· Obtain and maintain all documentation required by CMS to support claim billing
· Identify, compile and send all documentation necessary to respond to CMS pre and post payment audits
· Point of contact to assist internal and external customers with inquiries related to specialized Medicare Part B and/or Medicaid supply billing
· Process and submit overpayment refund requests and on account credits as needed
· Generate and work a variety of quality assurance reports
· Work backlog of rejected claims for timely resubmission
· Must meet monthly call volume, billing accuracy and productivity metrics
· Routinely monitor pharmacy dispensing and intake functions to identify any issues and bring to the attention of supervisor for continued process improvement considerations
· Identify NDC /manufacturer coverage issues and/or product setup issues and work with applicable designees to resolve
· Follow all applicable government regulations including HIPAA
· Employee is required to work the days and hours scheduled by immediate supervisor; subject to change due to business needs. Overtime may be required
· All other duties as assigned
Required Qualifications:· Strong verbal and written communication, interpersonal, and prioritization skills
· Must be highly organized and detail-oriented
· Ability to work in a fast paced, rapidly changing environment
· Requires the ability to exercise independent judgment and employ basic reasoning skills.
· Good computer skills requiring basic knowledge of Microsoft Word, Excel, PowerPoint, Outlook and good typing skills with minimal errors
· Demonstrate high level of integrity and professionalism to handle sensitive and confidential information
· Ability to perform basic mathematical calculations
· Ability to work both independently and as part of a team
Preferred Qualifications:· Prior experience in medical billing
· Basic knowledge of pharmacy operations
Education:High school diploma or equivalent Business Overview:
CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.
CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, 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
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For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-338-5609. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. Please note that we only accept resumes via our corporate website: https://jobs.cvshealth.com/