Medical Billing Representative, Revenue Cycle (Hybrid)

About the role

CVS Health Specialty Pharmacy, a mail service pharmacy in the Monroeville area, has an opportunity available for a full time Medical Billing Representative. As a Medical Billing Representative, you will ensure timely and accurate billing 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. We will support you by offering all the tools and resources you need to be successful in a collaborative team based environment.

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.
• Collaborate with collections team to ensure that payer guidelines are being met.
• Ability to spot inaccuracies or inconsistencies in medical documentation and ensure precision.

Requirements

• 1+ years Healthcare Insurance experience.
• Experience using Microsoft Office products specifically Excel, Outlook and Word.
• Must live within 1 hour of the Monroeville, PA office.

Preferred 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

• Anticipated Weekly Hours: 40
• Time Type: Full time

Pay

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.

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. Additional details about available benefits are provided during the application process and on Benefits Moments.