Job Description
Rep, QA Benefits and Authorization
remote type
Remote
locations
AZ – Phoenix
time type
Full time
job requisition id
R0084190
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.
A Brief Overview
- Provides support in ensuring accurate billing, efficient revenue flow, and compliance with regulations. Assists processing, insurance verification and authorization, revenue cycle management, compliance and documentation, as well as customer service and issue resolution.
What you will do- Quality review of benefit verification and authorization process to ensure accurate performance and outcomes.
- Feedback and training support
- 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- Minimum 1 year related work experience
Preferred Qualifications- Certified Professional, Life and Health Insurance Program (CPLHI) preferred.
- Certified Employee Benefit Specialist (CEBS) preferred.
Education- High School Diploma