Analyst, Revenue Cycle

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

The Revenue Cycle Associate will be involved in the company's day-to-day revenue cycle management and accounts receivable operations to ensure timely and appropriate submission of health care claims and subsequent payment for services rendered.

Core Responsibilities:

• Ensure payments are collected timely and in full from payers, and perform appropriate accounts receivable follow-up for denied claims

• Make use of all available tools (websites, electronic medical records, and payer systems) to efficiently identify reasons for non-payments, and follow the necessary steps for the insurance company to adjudicate the claims

• Work with insurance companies to follow up on denials of claims, make necessary corrections, and refile the claim to payer for reimbursement

• Process and upload checks/electronic payments for cash posting

• Review/approve patient statements prior to mailing

• Analyze data to identify trends and create reports for management

• Interact and collaborate with administrative staff within our clinics and our billing vendor to resolve billing questions

• Proficiency reading proper insurance plan and policy# from insurance ID cards

• Experience using Multi-payer web portals

• Ability to extract details from medical records to substantiate billing coding changes

• Communicate effectively using helpdesk ticketing system to reply to clinic inquiries regarding patient statements

• Contact payers to obtain clarification and/or details regarding incorrect payment/denials

• Effectively work edits within claim scrubbing software

• Accurately complete assignments in a timely manner

• Maintain working knowledge of company policies for collections, adjustments and write offs

• Possess strong critical thinking and problem solving skills to work through payers issues such as denials, underpayments and/or missing payment

• Adaptable to changing procedures and a growing environment

• Other duties as assigned

What are we looking for?

• The ideal candidate must have experience in health care accounts receivable follow-up,  a good understanding of the claims revenue cycle, and EPIC experience

• Must know how to read and interpret insurance Explanation of Benefits (EOB) statements

• At least 2 years of working on coding denials, and understanding of NCCI edits is preferred

• Solid understanding of insurance guidelines and principles including; COB, HIPAA, CPT, ICD-10, medical terminology, and managed care plans

• Time management skills, and the ability to meet deadlines is imperative

• education minimum of Associates degree, Bachelors preferred

• excel/google sheets experienced preferred

• CPB and /or CPC credentials are a plus

• US work authorization

• Someone who embodies being "Oaky"

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$43,888.00 - $93,574.00

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. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock