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Job Description Summary

The primary responsibility of the Medicare Part B Operations Coordinator is to support activities related to Medicare Part B end-to-end claims processing. The Coordinator will assist in ensuring CVS compliance to Centers for Medicare and Medicaid (CMS) requirements, resulting in successful claim processing and submission, through manual intervention - including prescriber and/or pharmacy outreach. This function supports the Revenue Cycle Team’s overall goal of timely and accurate billing of pharmacy and medical claims to Third Party Insurers.

Position Summary:

As a Medicare Part B Operations Coordinator, you will support the Revenue Cycle Medicare Part B Team in reducing bad debt, eliminating legal risk and ensuring compliance to all federal/state requirements and CVS Health obligations.

In this role, you will support the Medicare Part B Operations Teams initiative to collect and validate prescriber documentation in adherence to CMS requirements - documentation collection will be facilitated via prescriber fax and phone outreach. You will be responsible for maintaining and managing a central data repository of prescriber documentation. You will leverage this data source to identify actionable claim volume based on Standard Operating Procedures.

Additional responsibilities of the Medicare Part B Operations Coordinator will include:

• Performing root cause analysis and providing findings/suggestions to the Medicare Part B leadership team

• Assistance in the development of action plans to ensure continuous operational improvement

• Providing Medicare Part B claim adjudication support to pharmacies as needed

Required Qualifications:

• 1+ years (retail pharmacy, PBM, account management)

• 1+ years of professional MS Office experience

• 1+ years of professional MS Access experience

• Excellent diagnostic and organizational skills with a strong attention to detail, accuracy and follow through

• Demonstrated ability to communicate clearly, accurately and tactfully; both verbally and in writing, with both internal and external business partners

Preferred Qualifications:

• Ability to make sound business decisions independently or through team collaboration

• Ability to work individually or with a team with supervision

• Flexibility to adapt to a changing environment

• Strong organizational skills, attention to detail, accuracy and follow through

• Knowledge of medical billing and/or Medicare Part B Policy and Regulations

• Ability to work in strict confidence, ensuring the confidentiality of the patient and medical and financial records, in compliance with the company and HIPAA Privacy guidelines

• Rhode Island Pharmacy Technician License (Tech II)

• CPhT Certification by PTCB

Pay Range

The typical pay range for this role is:

$17.00 - $31.30

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 Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)

We anticipate the application window for this opening will close on: 11/16/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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.