Medical Billing & Accounts Receivable Representative

About the role

As a Medical Billing & Accounts Receivable Representative, you will ensure timely and accurate billing and follow-up for outstanding claims while demonstrating excellent customer service to patients, healthcare professionals and insurance carriers. 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.

Responsibilities

• Creating and submitting medical claims to insurance companies within timely filing and ensuring accuracy within payer guidelines and preferred bill methods (i.e., 837, website, spreadsheets, and CMS-1500)
• Validating coverage and eligibility prior to claim billing
• Resolve insurance problems and patient issues that may have resulted from incorrect or incomplete information, therapy changes and pharmacy or shipping errors
• Maintaining supporting and chronological notes that detail action taken to resolve billing edits
• Maintain updated information within the necessary AR/CVS systems that are in accordance with the company policy
• Following the company compliance regulations
• Being an effective communicator with patients, providers, and insurance agents to resolve account issues
• Research information on provider portals. Ensure that payer guidelines are being met
• Ability to spot inaccuracies or inconsistencies in medical documentation and ensure precision
• Following up on unpaid claims and initiating appeals for denied ones within standard payer guidelines
• Resolve issues with nonpayment of invoices due to insurance problems that may have resulted from incorrect or incomplete information, therapy changes and pharmacy or shipping errors
• Research and respond by telephone, via the internet and in writing to insurance companies and governmental payers regarding collection issues and problems
• Contact patients, physician’s offices, government agencies, and insurance companies for claim resolution
• Contact patients, physician’s offices, or payer entities to secure necessary documentation required for claim reimbursement

Requirements

• 1+ years Healthcare Insurance experience
• Experience using Microsoft Office products specifically Excel, Outlook and Word
• Bilingual in English and Spanish, with the fluent ability to communicate effectively in both written and verbal formats

Qualifications

• Insurance billing or collections experience
• Customer service in a healthcare and team environment
• Attention to detail
• Ability to multitask and meet deadlines
• Ability to utilize problem solving skills
• Ability to communicate with clientele in a professional manner

Education

Verifiable High School Diploma or GED required.

Schedule

Full time, 40 hours per week.

Pay

The typical pay range for this role is $17.00 - $25.65 per hour. This pay range represents the base hourly rate 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.

Benefits

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.