The primary responsibilities are to verify insurance coverage and perform benefit investigation for both new and existing patients in order to process patient prescription orders in a timely manner while demonstrating excellent customer service to patients, healthcare professionals and insurance carriers. This role will require an understanding of insurance carriers and concepts including drug cards, major medical benefits, and per diem coverage as well as knowledge of government and patient assistance programs.
1) Collect appropriate information needed to ensure insurance coverage for patient medication orders.
Pay Range
The typical pay range for this role is:
Minimum: 17.00
Maximum: 27.90
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
Required Qualifications
Six months experience working with medical insurance, benefits verification, medical billing, or a related field.
1+ years of experience in a Windows based computer utilizing Microsoft Office.
Preferred Qualifications
Pharmacy, PBM or Specialty pharmacy experience
Education
High School Diploma or GED required
Business Overview
Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
1) Collect appropriate information needed to ensure insurance coverage for patient medication orders.
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- Responsible for accurate and timely verification of new and existing patients’ prescription drug coverage specifically relating to disease state and type of prescriptions, supplies and services requested.
- Disposition and deny cases appropriately.
- Conduct benefit investigations and obtain prior authorizations when needed.
- Contact insurance carriers to resolve Electronic Claim Submission (ECS) rejections and other insurance related issues.
- Verify patient coverage with insurance companies.
- Secure and verify a method of payment (MOP) for patient’s financial responsibility to prevent company bad debt.
- Contact doctors’ offices for information to help resolve outstanding claims or insurance issues.
- Follow all procedures for payers and manufacturer programs to ensure all contractual obligations are met.
- Obtain or validate accurate patient information including diagnosis, insurance and financial information to complete enrollment applications for new patients.
- Appropriately document patient financial responsibility for the pharmacy.
Pay Range
The typical pay range for this role is:
Minimum: 17.00
Maximum: 27.90
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
jobs.CVSHealth.com/benefits
Required Qualifications
Six months experience working with medical insurance, benefits verification, medical billing, or a related field.
1+ years of experience in a Windows based computer utilizing Microsoft Office.
Preferred Qualifications
Pharmacy, PBM or Specialty pharmacy experience
- Knowledge of government and patient assistance programs
- Excellent customer service skills
- Attention to detail
- Analytical and problem solving skills
- Experience working with medical billing procedure
- Previous experience working with Prior Authorizations
- Knowledge of Medicare, Medicaid, and third party vendors
Education
High School Diploma or GED required
Business Overview
Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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