Medical Claims Refund Specialist

2 days ago


Monroeville, Pennsylvania, United States CVS Health Full time
Job Summary

CVS Health is seeking a highly skilled Medical Claims Refund Specialist to join our team. As a key member of our Refund team, you will play a critical role in ensuring timely credit balance resolution via refunds to patients, governmental agencies, and other third-party payers.

Key Responsibilities
  • Review and verify the validity of credit balances by analyzing accurate billing and posting procedures.
  • Perform analytical activities for the reimbursement/collections department, managing healthcare accounts receivable.
  • Initiate refunds, offsets, and adjustments to resolve outstanding balances.
  • Analyze issues and search for solutions to ensure efficient resolution.
  • Maintain chronological notes detailing action taken to resolve outstanding balances.
Requirements
  • 1+ years' experience in healthcare reimbursement, medical billing, or insurance collections, and/or account reconciliation/account review/account resolution.
  • 1+ years' experience in Microsoft Office Suite, specifically Microsoft Excel, Microsoft Outlook, and Microsoft Word.
  • Must live within a 1-hour commute from Monroeville, PA office.
Preferred Qualifications
  • Strong written and verbal communication skills.
  • Strong team-oriented and collaboration skills.
Benefits

CVS Health offers a comprehensive benefits package, including medical, dental, and vision benefits, 401(k) retirement savings plan, and employee stock purchase plan. We also offer a fully-paid term life insurance plan, short-term and long-term disability benefits, and numerous well-being programs.



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