Medical Billing Specialist | Claims & Eligibility

CVS Health; Monroeville (Allegheny County); On-site; USD 23,000 - 39,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Other resources, based on eligibility

Job summary

CVS Health in Monroeville, PA is seeking a Medical Billing Representative to submit medical claims to insurers, verify coverage, and resolve payer and patient issues. You’ll work with 837, CMS-1500, and CVS systems to ensure accuracy and compliance.

Qualifications include 1+ year healthcare insurance experience and proficiency with Excel, Outlook and Word. Must live within 1 hour of the Monroeville office and be able to work in a fast‑paced, detail‑driven team environment.

Qualifications

• 1+ years Healthcare Insurance experience.
• Proficient in Excel, Outlook & Word.
• Live within 1 hour of the Monroeville, PA office.
• Ability to submit medical claims and verify eligibility.

Responsibilities

• Creating and submitting medical claims to insurance companies within timely filing and ensuring accuracy within payer guidelines and preferred bill methods (i.e., 837, website, spreadsheets, and CMS-1500).
• Validating coverage and eligibility prior to claim billing.
• Resolve insurance problems and patient issues that may have resulted from incorrect or incomplete information, therapy changes and pharmacy or shipping errors.
• Maintaining supporting and chronological notes that detail action taken to resolve billing edits.
• Maintain updated information within the necessary AR/CVS systems that are in accordance with the company policy.
• Following the company compliance regulations.
• Being an effective communicator with patients, providers, and insurance agents to resolve account issues.
• Research information on provider portals.
• Collaborate with collections team to ensure that payer guidelines are being met.
• Ability to spot inaccuracies or inconsistencies in medical documentation and ensure precision.

Skills

Healthcare insurance experience

Microsoft Excel

Microsoft Outlook

Microsoft Word

Communication skills

Attention to detail

Time management

Education

High School Diploma or GED

Tools

Microsoft Office

Job description

CVS Health in Monroeville, PA is seeking a Medical Billing Representative to submit medical claims to insurers, verify coverage, and resolve payer and patient issues. You’ll work with 837, CMS-1500, and CVS systems to ensure accuracy and compliance.

Qualifications include 1+ year healthcare insurance experience and proficiency with Excel, Outlook and Word. Must live within 1 hour of the Monroeville office and be able to work in a fast‑paced, detail‑driven team environment.