We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
The Adjudication Associate (Omnicare) is responsible for the preparation and submission of claims for accounts to ensure timely reimbursements. This person will communicate with the nursing facility staff, physician offices, and insurance companies to maintain payment deliverables for online claim submissions.
Responsibilities:
- Follows established procedures to execute routine business support tasks for the Adjudication Omnicare function under general supervision.
- Develops effective relationships with all team members to ensure daily communication to resolve issues and prevent delays in service.
- Conducts review and research of rejected claims and takes action for resolution.
- Handles work backlog of denied claims for timely resubmission.
- Ensures compliance with all government and regulatory requirements.
- Takes direction to execute techniques, processes, and responsibilities.
Required Qualifications
- At least 1 year of experience in customer service.
- Basic proficiency with desktop software applications, particularly Microsoft Excel and Microsoft Access.
- Must be able to work overnight (9pm-5:30am EST), as well as be willing to work weekends and holidays on a rotating schedule.
Preferred Qualifications
- Pharmacy technician certification.
- Experience in pharmacy, managed care, Medicaid and/or Medicare organizations.
- Ability to perform multiple tasks effectively.
- Ability to work both independently and as part of a team.
Education
- High School Diploma or GED.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$17.00 - $34.15This 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.
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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- At least 1 year of experience in customer service.
- Basic proficiency with desktop software applications, particularly Microsoft Excel and Microsoft Access.
- Must be able to work overnight (9pm-5:30am EST) and be willing to work weekends and holidays on a rotating schedule.
- High School Diploma or GED.
- Pharmacy technician certification.
- Experience in pharmacy, managed care, Medicaid and/or Medicare organizations.
- Ability to perform multiple tasks effectively.
- Ability to work both independently and as part of a team.
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
