Senior Revenue Cycle Lead - Claims & Billing Impact

CVS Health; Monroeville (Allegheny County); On-site; USD 26,000 - 48,000; Full time

Job summary

CVS Health is seeking a Senior Lead Coordinator to implement and maintain comprehensive billing review processes and identify trends for management and payer partners. You will mentor staff and design training programs to build a high performing, engaged team.

You will lead claims review, collaborate with clinical and administrative teams, ensure documentation accuracy, and drive revenue cycle improvements while ensuring compliance with policies.

Qualifications

• 2+ years experience in medical benefit insurance verification.
• 18+ months experience as a Medical Billing or Collections Specialist.
• High level of proficiency with Excel.
• Excellent communication, organizational and interpersonal skills.
• Extreme accuracy and attention to data standards.
• Must live within 1 hour commute to Monroeville office.

Responsibilities

• Review and analyze patient profiles, benefits, and prior authorizations to identify issues affecting claims.
• Collaborate with clinical and administrative teams to ensure accurate documentation for claims processing.
• Monitor claims submissions and follow up on pending claims to expedite payment.
• Identify trends in denials and develop improvement strategies.
• Conduct training sessions for staff on claims submissions and compliance.
• Maintain knowledge of insurance policies, regulations, and trends impacting claims.
• Prepare reports on claims performance metrics for leadership.
• Act as liaison between organization and payers to resolve complex claims issues.
• Provide guidance to coordinators and staff to foster teamwork and excellence.
• Ensure compliance with regulatory requirements and patient data management policies.
• Analyze workflows to identify bottlenecks and implement process improvements.
• Collaborate to implement new billing and coding technology and train staff.
• Coordinate with external stakeholders to resolve billing and reimbursement issues.
• Implement internal controls and billing procedures for reconciliation integrity.

Skills

Excel proficiency

Communication

Organizational skills

Problem solving

Attention to detail

Education

Associates degree or equivalent

Tools

Excel

Job description

CVS Health is seeking a Senior Lead Coordinator to implement and maintain comprehensive billing review processes and identify trends for management and payer partners. You will mentor staff and design training programs to build a high performing, engaged team.

You will lead claims review, collaborate with clinical and administrative teams, ensure documentation accuracy, and drive revenue cycle improvements while ensuring compliance with policies.