Position Summary: This position is responsible, under the Manager of the Payer Enrollment Dept. to:
- Ensuring timely and accurate processing of Payer Enrollment applications (Initial and Revalidations) for Clinics and Providers.
- Provide quality control for timely and accurate individual enrollment applications submitted for Medicare and Medicaid programs.
- Resolve claims issues for individual payers in corporate billing system.
- Researching, completing and maintaining compliance with individual Government payers through credentialing, re-credentialing and audit processes and procedures.
- Contact Providers when Revalidation notices are received in order to obtain signature pages and validate current general information. Interact with the field (SPM and CPM’s) in regards to escalation notices.
- The Payer Enrollment Coordinator will be responsible for identifying and quantifying trends/issues and then effectively communicating them to the appropriate members of the management team along with what the potential impact could be.
- Minimize denials and deactivation of government applications where applicable to reduce key metrics including DSO, cost to collect, percent of aged claims, and Bad Debt. Update Credentialing and Billing systems with Provider information upon inquiry or receipt from Government /Commercial payers.Required Qualifications:- 1+ years experience in Medicare/Medicaid, provider enrollment, data management, and/or other relevant work experience.
- 2+ years’ experience in Medicare/Medicaid, provider enrollment, data
management, and/or other relevant work experience.
- Demonstrated understanding of insurance and billing procedures regarding Medicare, Medicaid, and Commercial in multi state, multi-entity environment.
- Provider/Clinic Enrollment with government audit/compliance experience.
- Excellent written and verbal skills including formal and effective presentation and ability to impact and influence peers, leaders and key stakeholders.
- Project planning and the ability to participate on multiple cross-functional project teams to achieve on-time results.
- Ability to understand data, analyze reporting and make sound recommendations and business decisions.
- Strong credibility and relationship management skills with internal and external customers.
- Work all claim holds, (i.e trends, denials, provider, clinic, non-billable services, determine if there is payer/provider issue, log all claims daily in excel/access, weekly summary reporting and resolution). Education: 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: https://jobs.cvshealth.com/