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.
A Brief Overview
Assists with processing, insurance verification and authorization, revenue cycle management, compliance and documentation, as well as customer service and issue resolution. Provides support in ensuring accurate billing, efficient revenue flow, and compliance with regulations.
What You Will Do
- Gathers necessary information to verify critical member benefits insurance coverage, such as policy numbers, group numbers, and demographic details.
- Reviews insurance plans and policies to determine the extent of coverage for different medical procedures, treatments, medications, or services.
- Contacts insurance providers to verify eligibility, coverage limits, pre-authorization requirements, and any specific benefits relevant to member services or treatments.
- Explains the verification process, provides updates on the status of benefits verification, and addresses any questions or concerns related to coverage or financial responsibility.
- Maintains accurate and detailed records of insurance verification activities, including documenting conversations, collecting insurance information, and updating patient or member profiles.
- Communicates any authorization requirements, coverage limitations, or pre-certification processes to ensure smooth billing and claims processing.
- Investigates and resolves any challenges or conflicts that may arise during the verification process, working closely with insurance providers, patients, or members to find resolutions.
- Proposes process enhancements, automation, or system improvements to streamline operations and enhance the overall effectiveness of benefits verification activities.
- Responds to member inquiries and concerns promptly, empathetically, and professionally, ensuring a positive customer experience.
For This Role You Will Need Minimum Requirements
- Less than 1 year work experience
Preferred Qualifications
- Certified Professional, Life and Health Insurance Program (CPLHI) preferred.
- Certified Employee Benefit Specialist (CEBS) preferred.
Education
Position Summary
Coram/CVS Health is looking for a high-energy healthcare professional to join our national team as a Benefit Verification Specialist! This rewarding opportunity allows you to work closely with our Patient Intake Coordinators and insurance providers to verify coverage for in-home IV therapy for Coram's patients. We believe that Benefit Verification Specialists are a key part of creating a positive experience for our patients.
In this dynamic and fast-paced role, you will be responsible to verify insurance coverage, perform benefit investigation, and obtain prior authorization for both new and existing patients in order to process patient prescription orders in a timely manner while demonstrating excellent customer service directly 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.
The schedule for this position is Monday - Friday with hours between 8:30am-6:30pm CST. Colleague will be required to work mandatory overtime/extended work week when needed, as well as regular and predictable attendance. This role may require on-call scheduling based on departmental need. Preference will be given for later shift availability. This is a Work At Home role, which requires access to an appropriate work space that will ensure HIPPA compliance, privacy and consistent internet strength and availability.
Required Qualifications
- Analytical and problem-solving skills
- Attention to detail
- Ability to work independently
- Experience working in Microsoft Office, specifically Excel, Outlook and Word
- Strong computer skills
Preferred Qualifications
- Minimum one year experience working in a healthcare environment
- Experience working with health care insurance and medical terminology.
- Knowledge of Medicare, Medicaid, and third-party vendors
- Prior direct customer service experience (medical field preferred)
- Epic experience
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: 01/08/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
