CVS Health

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Healthcare Billing Consultant - Audit

at CVS Health

Posted: 6/5/2019
Job Reference #: 1000341BR
Keywords: billing, compliance

Job Description

Job Title :
Healthcare Billing Consultant - Audit
Job ID :
Location :
Street Address :
Category :
Audit|Billing & Collections|Omnicare
Description :
Job Description
As a Consultant, Billing Audit you will directly support the Key Account Auditor as part of the billing audit relationship with Band 1 and at risk customer accounts which represent 75% or more of Omnicare’s business (nearly $2 billion in revenue annually) by performing detailed reviews of assigned reports and interacts with local billing offices to make corrections prior to invoicing. You will be the technical person that reviews their pre-billing reports for any errors and works with the appropriate Omnicare departments to ensure errant charges are addressed and reports any patterns of errors to supervisor.

This position requires a highly technical skillset and enhanced knowledge of the Omnicare legacy dispensing systems, OmniView and RxClaim.

In this role you will:

- Maintain knowledge of all aspects of the customer level Preferred Provider Agreement (PPA), customer facility non-covered rules, and adjudication rules for invoice pricing and clinical edits on RxClaim.
- Perform independent focused review of pre-billing reports and transactions prior to invoice generation to ensure contract compliance and billing accuracy.
- Assist Key Account Auditor with audits submitted by customer and external audit companies on behalf of customer. Provide timely and accurate responses to customer and external audit vendor inquiries ensuring responses adhere to customer contract and internal policies and procedures.
- Perform root cause analysis of customer issues related to billing, formulate and deliver corrective action plans to appropriate departments for resolution.
- Maintain knowledge of company policies and procedures and related business operations to ensure timely and accurate billing.
- Maintain database customer unbilled non-covered charges, house stock and various requested reports for ad-hoc audit requests from customer senior level designees or strategic account executive.
- Assist with projects, training, and escalated concern resolution as requested by management.
- Follow all applicable government regulations including HIPAA.
- Demonstrate behavior which exemplifies employee code of conduct guidelines and CVS’ established Core Values.
- Other duties as assigned.

Required Qualifications
- Minimum of 3 years of Medicare, Medicaid and Medicare Part D experience.
- A minimum of 3 years long term care billing experience.

Preferred Qualifications
- Working knowledge of Omniview, Microstrategy, and other operating systems
- Enhanced knowledge of LTC facility, Medicare D and Medicaid billing
- Ability to work in a fast paced, rapidly changing environment
- Ability to work independently and part of a diverse team
- Advanced verbal and written communication skills
- Strong knowledge of pharmacy policies and procedures
- Excellent collaboration skills and ability to influence others
- Ability to build credible relationships with customers and business partners
- Strong problem solving and organization skills, ability to create and execute action plans
- Excellent time management skills including planning and ability to set, maintain, and meet strict deadlines
- Proficiency with Windows 2010, MS Excel, MS Access, and MS Power Point; ability to learn and apply job related healthcare and other software

- High School Diploma or Equivalent
- Bachelors Degree preferred.

Business Overview
It’s a new day in health care.

Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation’s premier health innovation company. Through our health services, insurance plans and community pharmacists, we’re pioneering a bold new approach to total health. As a CVS Health colleague, you’ll be at the center of it all.

We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.

CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran - we highly value and are committed to all forms of diversity in the workplace. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT. We provide reasonable accommodations to qualified individuals with disabilities. If you require assistance to apply for this job, please contact our Advice and Counsel Reasonable Accommodations team. Please note that we only accept applications for employment via this site.

If technical issues are preventing you from applying to a position, contact Kenexa Helpdesk at 1-855-338-5609 or For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!