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Position Summary

CVS Health Specialty Pharmacy, a mail service pharmacy in the Monroeville area, has an opportunity available for a full time Pharmacy Claims Biller/Adjustment Specialist.  As a Biller/Adjustment Specialist, you will ensure timely and accurate billing for outstanding claims while demonstrating excellent customer service to patients, healthcare professionals and insurance carriers. You will review requests for claim reconciliation and process appropriate adjustments.  As part of the billing and reimbursement team, you will work in a fast paced and team focused environment to ensure timely and accurate billing to insurance providers. Located in the Monroeville Facility, this opportunity also provides free parking. We will support you by offering all the tools and resources you need to be successful in a collaborative team-based environment.

Role Overview

• Hybrid Role
• Shift: Monday-Friday, 8:00AM-4:30PM EST (Flex Start)
• Training: First 2-3 weeks of employment.

What you will do

• Third party insurance claim billing associated with the dispensing medication and using the bill method required by the payer.
• 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.
• Maintain supporting and chronological notes that detail action taken to resolve billing edits.
• Maintain patient demographic and insurance information and data collections systems, including all billing reports, work queues, or diversions according to payer and company policy guidelines.
• Research and respond to insurance companies and governmental payors regarding billing issues or related questions by telephone, via the internet, and in writing.
• Contact patients, physician’s offices or insurance carriers as needed in order to expedite billing claims.
• Process adjustments based information provided in work queues or requests submitted through other areas in the organization. 

Required Qualifications

• 1 year of Healthcare Insurance Billing or related experience.
• Experience using Microsoft Office products specifically Excel, Outlook and Word.
• Must live within a 1 hour commute from Monroeville, PA.

Preferred Qualifications

• Insurance billing or collections experience.
• Customer service in a healthcare environment.
• Experience working in a healthcare reimbursement system.
• Effective customer service skills and experience that shows ability to work in a team environment.
• Attention to detail.
• Ability to utilize analytical skills.
• Ability to communicate with clientele in a professional manner; both verbally and written.

Education

• High School Diploma or GED.

Pay Range

The typical pay range for this role is:

$17.00 - $28.46

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.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
 
For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 02/07/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.