Job Title: Medicare Billing Collections Specialist - Monroeville, PA (Hybrid)

Job Description:
The Medicare Billing Collections Specialist will be responsible for managing and overseeing the billing and collections process for Medicare-related claims. This hybrid role, based in Monroeville, PA, involves both remote and onsite work to ensure timely and accurate submission of claims, as well as follow-up on outstanding collections. The ideal candidate will have a strong background in Medicare billing processes, outstanding organizational skills, and the ability to work efficiently in a fast-paced environment.

Key Responsibilities:

• Review and process Medicare claims for accuracy and compliance with regulations.
• Follow up on unpaid or denied claims, ensuring all appropriate actions are taken for resolution.
• Communicate with insurance providers, patients, and healthcare teams to resolve billing and collection issues.
• Maintain accurate records of billing activities and payments in the system.
• Prepare and submit appeals for denied claims, ensuring all documentation is provided.
• Ensure compliance with all Medicare billing regulations and policies.
• Provide regular updates and reports to management on the status of collections and outstanding accounts.
• Address patient inquiries related to billing issues, providing clear and accurate information.
• Collaborate with other departments to resolve issues and improve processes.

Requirements:

• High school diploma or equivalent; Associate’s degree or certification in healthcare billing preferred.
• Previous experience in Medicare billing, collections, or related healthcare finance positions.
• Strong knowledge of Medicare regulations, billing codes, and insurance processes.
• Proficiency with billing software and Microsoft Office Suite.
• Excellent communication and customer service skills.
• Detail-oriented with strong problem-solving abilities.
• Ability to work both independently and in a team setting.

Benefits:

• Competitive salary and performance-based incentives.
• Comprehensive health benefits (medical, dental, and vision).
• 401(k) with employer matching.
• Paid time off (PTO) and holiday benefits.
• Employee wellness programs and support.
• Flexible hybrid work schedule (remote and in-office).

Company Overview:
We are a leading healthcare provider committed to offering high-quality, compassionate care. Our dedicated team works collaboratively to ensure that patients receive the care they need while ensuring the smooth operation of our billing and collections processes. We take pride in maintaining compliance with Medicare policies and strive to improve healthcare outcomes for our patients.

Equal Opportunity Employer Statement:
We are an Equal Opportunity Employer and value diversity in the workplace. We encourage applicants from all backgrounds and walks of life to apply. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetics, disability, age, or veteran status.

If you're a detail-oriented and experienced billing professional with a passion for Medicare processes, apply today to join our team as a Medicare Billing Collections Specialist

Job description

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: CVS Health Specialty Pharmacy, a mail service pharmacy in the Monroeville area has an opportunity for a full-time Insurance Billing/Collections Representative to handle timely billing and insurance follow up. The Insurance Billing/Collections Representative will ensure timely billing and accurate account payment for outstanding balances while demonstrating excellent customer service to patients, healthcare professionals and insurance carriers. We will support you by offering all the tools and resources you need to be successful in a collaborative team environment. Located in the Monroeville facility, this opportunity also provides free parking. What you will do Timely response to Medicare audits and appeals Research and gather the appropriate documentation to form all levels of appeals for Medicare Third party follow-up associated with the dispensing g of prescription medication via telephone, Internet, and in writing Resolve issues with nonpayment of invoices due to insurance problems that may have resulted from incorrect or incomplete information, therapy changes and pharmacy or shipping errors Maintain supporting chronological notes that detail action taken to resolve outstanding account balances Maintain patient demographic information and data collection systems Research and respond by telephone, via the internet and in writing to insurance companies and governmental payers regarding collection issues and problems Contact patients and Physician’s offices as well as insurance companies as needed in order to expedite claims processing Required Qualifications 6 months or more related work experience. Must live within a 1 hour commute from the Monroeville, PA office. Experience using Microsoft Office products’ specifically Excel, Outlook and Word. Preferred Qualifications Insurance billing or collections experience Working knowledge of problem solving and decision making skills 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 navigate through multiple tasks simultaneously and prioritize based on importance while displaying strong attention to detail Ability to communicate with clientele in a professional manner; both verbally and written Certified Billing and Coding Specialist (CBCS) preferred but not required . Education High School Diploma or GED Pay Range The typical pay range for this role is: $17.00 - $28.46 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 We anticipate the application window for this opening will close on: 12/31/2024 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.