Manager Revenue Cycle

Job DescriptionThe Manager, Revenue Cycle is responsible for strategic oversite of the CVS Specialty post shipment revenue cycle department, identifying and implementing best practices across the Copay Assistance/Foundation payers and credit balances for both the medical and pharmacy benefit plans. In this role, the Manager is expected to create simplicity by developing strategies that contribute to the highest degree of productivity and accuracy and leading innovation through system enhancements and process redesign, including collaboration with Trade and/or the payer, possible Digital or automation opportunities. In addition, the Manager is expected to maintain 100% credit compliance with our Government payers and resolve other credit balances within department guidelines. The Manager, Revenue Cycle is also responsible for providing leadership and guidance to the department Supervisors and colleagues to ensure overall goals and priorities of the company and department are successfully performed. In addition, the Manager, Revenue Cycle will provide oversite for the following functions Control processes that monitor and drive resolution. Identification and resolution of the unbilled and billed/denied claims critical to Manufacturer/Copay Assistance payer issues as it relates to billing and collections. Identification and resolution of credit balances as it relates to all payers and customers. Strategic system enhancements, including Digital and Automation opportunities. Collaboration with payers, Trade, and other internal departments on implementation of new programs or payers. Ensure new programs are set up appropriately within our host system to comply with payer requirements, including but not limited to bill group set up, refund/offset processes, edits and or any training needs are met. Collaboration to ensure compliance with our Government payers, larger client requirements, and regular book of business. Collaboration with the Dedicated BV Team and ECS Billing Team for resolution of post-shipment escalations, resulting in no negative impact to our customers. Proactive and effective communication of department results and updates to senior business leaders.The Manager, Revenue Cycle is the primary contact for internal and external business partners for CVS Specialty for Foundation/Copay Assistance Programs and credit balances.Required Qualifications Two or more years management experience in healthcare revenue cycle, managing various levels of employees including exempt and non-exempt staff. Experience in managing Revenue Cycle AR TeamsCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications Experience in large, specialty pharmacy reimbursement environment functioning as an expert biller or collector Proficient in Microsoft office products including Excel, Word, Outlook, Teams, and One Note Proven ability to collaborate across business lines to work towards enterprise goals and objectives. Ability to manage multiple workstreams and deliver results that meet or exceed expectations. Ability to effectively manage and provide team leadership. Extreme accuracy, organizational skills, and attention to detail. Ability to work in teams and coordinate work efforts. Exceptional verbal, interpersonal and written communication skills. Attention to customer focus to respond with accurate and timely information. Ability to evaluate work and process flow to ensure optimal efficiencies. Ability to manage multiple priorities. Experience in a high intensity, fast paced production environment. Experience working with revenue cycle applications and healthcare finance and accounting principles. Experience in large, specialty pharmacy reimbursement environment, preferably functioning as an expert biller or collectorEducationHigh School Diploma/GED requiredBachelor's degree in business administration, accounting or finance preferredBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2024-10-19