CVS Health

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

CVS Health, Specialty Pharmacy, a mail service pharmacy in Monroeville area has an opportunity for a full-time Reimbursement Specialist. The Reimbursement Specialist is primarily responsible for monitoring Payer reimbursement data and maintaining coverages in multiple systems and reports to ensure compliance with expected pricing, reimbursement rates in support of accurate billing and collections and contract/payer agreement compliance. The Reimbursement Specialist will also be responsible for Payer Contract Creation and Maintenance in support of accurate billing and collections. Your role is critical to ensure a smooth flow of payment to payers that allows CVS Health to quickly dispense and bill for thousands of medications that are vital to the health of our patients. You will routinely interface with multiple internal groups, including medical billers and coders, pharmacy technicians, and contract sales associates. Various other tasks and projects will also be assigned by their leadership team. As part of this team, you will work in a fast paced and team focused environment.

We will support you by offering all the tools and resources you need to be successful in a collaborative team environment.

We offer a comprehensive benefits package which includes medical, dental, vision insurance as well as a comprehensive list of supplemental lists of benefits and discount programs. In addition to sixteen paid days off for employees, we also offer ten paid holidays.

Located in the Monroeville facility, this opportunity also provides free parking.

Key Responsibilities of the Reimbursement Coordinator:

• Setting up and maintaining assigned payers pricing, coverages and formulary within our internal systems according to contract/fee schedules.
• Analysis and entry of billed and booked pricing. Requesting reports and escalating to business owner when necessary
• Reimbursement rates in support of accurate billing and collections and contract/payer agreement compliance.
• Ensuring comprehension and timely completion of Payer Code Creation and Maintenance across all lines of business.
• Serves as a critical point of contact to healthcare billing and reimbursement operations.
• Routinely interface with multiple internal groups, including medical billers and coders, pharmacy technicians, and contract sales associates.

Required Qualifications

• 18+ months experience within healthcare or direct experience working for CVS Specialty Reimbursement Payer Relations.
• 12+ months experience using Microsoft Office products’ specifically Excel, Outlook, and Word.
• Must be able to commute to the Monroeville, PA office.

Preferred Qualifications

• Experience with SharePoint
• Experience interfacing with payers in a healthcare environment.
• Ability to work in a team setting along with working independently.
• Ability to prioritize.

Education

• Verifiable High School Diploma or GED required.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$17.00 - $28.46

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 05/31/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.