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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.

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

• 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.

• 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.

• 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.

• High School Diploma or GED.