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Job Description

A Billing Adjudicator is responsible for preparing and submitting claims for accounts and works with nursing facility staff, physician offices and insurance companies to ensure timely payment of online submission of claims.


* Review and research rejected Third Party claims taking appropriate action to resolve
* Work backlog of rejected claims for timely resubmission
* Manage assigned queues keeping up to date and current on all claims
* Workflow grid is cleared daily to meet productivity criteria
* Specific denials including new patient overrides
* Follow all applicable government regulations including HIPPA
* Display behavior which exemplifies the CORE VALUES
* Other duties as deemed necessary

Schedule: Monday- Friday, with rotating weekends, 9:30 pm - 6:00 am

Required Qualifications

MINIMUM REQUIRED (must be met in order to perform the job at the required level)

* High School Diploma
* Entry-level familiarity with EXCEL/ACCESS
* Perform multiple task effectively
* Able to work both independently and as part of a team

Preferred Qualifications

PREFERRED ( if above and beyond the minimum required)

* Pharmacy Technician Certification highly preferred
* Experience in the pharmacy, managed care, Medicaid, and/or Medicare organizations


High School Diploma or equivalent

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-###-#### or ...@us.ibm.com. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-###-####.
Associated topics: aseptic technique, dietary, dietetic, immunoassay, immunohematology, injury, nutritionist, pharmacy, protein, trauma

* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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