Medical Collections Specialist

Job Description
CVS Health, Specialty Pharmacy, a mail service pharmacy in the Monroeville area, has an opportunity available for a full time billing/insurance follow up representative. The primary responsibilities of a Medical Collections Specialist are to ensure timely and accurate account payment for outstanding balances while demonstrating excellent customer service to patients, healthcare professionals and insurance carriers.  

Responsible for all third party follow-up associated with the dispensing of prescription medication; maintain supporting chronological notes that detail action taken to resolve outstanding account balances. Maintains patient demographic information and data collection systems. Work all billing/collection reports, queues, or diversions according to payer and company policy guidelines. 

Researches and responds by telephone, via the Internet and in writing to insurance companies and governmental payors regarding billing issues and problems. Follows up on submitted claims; monitors unpaid claims, initiates appeals and resubmits claims as necessary. Easily identifies payor trends, prepares projects for escalations and all other duties as assigned to ensure timely and accurate reimbursement. 

-Transmit or submit claims (paper, electronic) to insurance payors for reimbursement  
-Resolve insurance problems and patient issues that may have resulted from incorrect or incomplete information, therapy changes and pharmacy or shipping errors  
-Provide detailed follow up with patients and payors in the form of, but not limited to phone calls, fax transmittals and e-mails  
-Contact patients and Physician’s offices as needed in order to expedite claims processing  
-Obtain accurate demographic, insurance and financial information from patients to ensure all account information is accurate  
-Located in the Monroeville Facility, this opportunity also provides free parking

Required Qualifications
- 1 + years experience performing health care reimbursement, medical billing or insurance collections 
- 1+ years experience in Microsoft Office, specifically Excel, Outlook and Word 

Preferred Qualifications
-1+ years of experience with collections associated with Medical billing or collections in health care 
- Customer Service in a health care environment and with healthcare reimbursement 
- Ability to communicate with clientele in a professional manner; both written and verbal  
- Proven effective customer service skills and experience that shows ability to work independently and in a team environment 
- Ability to navigate through multiple tasks simultaneously and prioritize based on importance while displaying strong attention to detail  

- Verifiable High School Diploma or GED required.

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

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking EEO AA CVS Health

CVS Health does not require nor expect that applicants disclose their compensation history during the application, interview, and hiring process.

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: