Our Ability Jobs

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.

Position Summary

Responsible for the accurate analysis and resolution of provider participation and pricing disputes. This will require knowledge of healthcare processes and internal operation requirements, policies, and procedures. You will:

Review provider dispute resolutions according to organizational guidelines.

Research and respond to provider participation and pricing inquiries related to Network contracts and agreements.Research identified issues; submit claim adjustment requests and determine the root cause of disputes.Serve as subject matter expertise in evaluating and responding to provider participation and pricing inquiries.Analyze post-paid healthcare claims as it relates to pricing needs.Apply in-depth research to determine accuracy of PPO(s) use and pricing discounts applied.Communicate externally and with internal departments as it related to the cases under review.Coordinate with other departments as necessary to facilitate resolution of claim related participation and pricing issues.

Required Qualifications

Self-motivated, detail-oriented, deadline-driven individual with:

Two or more years of healthcare experience in a managed care environment.One or more years of experience with provider disputes.Computer proficiency with Microsoft OfficeStrong math, communication, analytical, critical-thinking, and problem-solving skills.Knowledge of medical terminology, claim forms, and physician billing coding.Ability to read/interpret appeals, standard reference materials, etc.

Preferred QualificationsClaims processing experience.Customer service experience.

DG system experience.

2+ years in-depth knowledge of Meritain products, services and system capabilities.

EducationHigh School Diploma (minimum)

Pay Range

The typical pay range for this role is:

$18.50 - $37.02

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

We anticipate the application window for this opening will close on: 07/24/2024

We are an equal opportunity and affirmative action employer. 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.