Claim representative [h1.location_city]

Claim Field Analyst

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

The Claim Field Analyst acts as the primary resource for groups and providers, within a specific geographic location, to establish, oversee, and maintain a proactive claim education program focused on assisting providers with claim denials, claim education, and claim resolution.

This person analyzes claim denials to track and trend potential opportunities, in order to assist in training and education of participating and non-participating providers. Additionally, they will assist in creating bulletins, newsletters, and claim trainings to improve provider claims issues. as well as billing practices, while collaborating with internal and / or external departments to identify claim training and education opportunities. This person will develop, implement, support, and promote provider training strategies, tactics, policies, and programs that drive provider satisfaction specific to claim submission and payments.

The Claim Field Analyst works with the grievance and appeal and claims operations department to trend provider claim issues or concerns that could be prevented with additional provider claim education. They also work with the provider engagement team to collaborate on provider education when additional detailed claim education is needed.

The Claim Field Analyst meets regularly, both in person and virtually, with assigned providers to conduct trainings and educations, review claim trends, and ensure understanding of Aetna Medicaid claim and billing policies and procedures. This person is expected to spend 70% of their time meeting with providers in-person, as well as conducting occasional telephonic or virtual provider meetings as needed.

The Claim Field Analyst responds to assigned provider claim questions or inquires, and if necessary, ensures prompt resolution to provider issues with appropriate enterprise business teams. Other duties as assigned.

Required Qualifications

• 3+ years of experience in medical billing and coding, specifically related to claims processing and root cause analysis.
• 3+ years of experience with provider engagement / relations.
• Working proficiency of Microsoft Office products (Word, Excel, PowerPoint, Outlook).
• Advanced experience in Microsoft Excel for data mining.
• Must reside in Central Florida - Tampa (Region D - Hardee, Highlands, Hillsborough, Manatee, Polk) and / or Orlando (Region E - Brevard, Orange, Osceola, Seminole).
• Ability to travel 70% of time within Central Florida and will work remotely the remaining 30% of the time.
• Ability to work Monday-Friday from 8am-5pm EST, with the flexibility to work beyond core hours as needed.

Preferred Qualifications

Education

Anticipated Weekly Hours : 40

Time Type : Full time

Pay Range : The typical pay range for this role is : $46,988.00 - $91,800.00

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include :

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