# Claim Field Specialist

**Company**: CVS Health
**Location**: Field, Florida
**Job type**: full-time
**Salary**: $46,988.00 - $102,000.00
**Category**: Healthcare
**Industry**: Healthcare

**Apply**: https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/Field-Florida/Claim-Field-Specialist--South-Florida-_R1088643?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/jobs/job_86b6d390-d63

## Description

We're building a world of health around every individual , shaping a more connected, convenient, and compassionate health experience.

The Claim Field Specialist acts as the primary resource for groups and providers within a specific geographic location to establish, oversee, and maintain a proactive claim education program focused on assisting providers with claim denials, claim education, and claim resolution.

This person analyzes claim denials to track and trend potential opportunities to assist in training and education of participating and non-participating providers. They will assist in creating bulletins, newsletters, and claim trainings to improve provider claims issues and billing practices while collaborating with internal and external departments to identify claim training and education opportunities.

The Claim Field Specialist works with the grievance and appeal department to trend provider claim disputes and appeals that could be prevented with additional provider claim education. They also work with the provider engagement team to collaborate on provider education when additional detailed claim education is needed.

The Claim Field Specialist meets regularly with assigned providers to conduct trainings and educations, review claim trends, and ensure understanding of Aetna Medicaid claim and billing policies and procedures. This person is expected to spend 70% of their time meeting with providers in-person and conducting occasional telephonic or virtual provider meetings as needed.

The Claim Field Specialist responds to assigned provider claim questions or inquiries and ensures prompt resolution to provider issues with appropriate enterprise business teams.

**Required Qualifications**

- 2+ years of experience in medical billing and coding, specifically related to claims processing and root cause analysis.

- 2+ years of experience with provider engagement and/or relations.

- Working proficiency of Microsoft Office products (Word, Excel, PowerPoint, Outlook).

- Advanced experience in Microsoft Excel for data mining.

- Must reside in Central Florida, specifically Orlando (Region E - Brevard, Orange, Osceola, Seminole).

- Willingness to travel 70% of time within Central Florida and work remotely the remaining 30% of the time.

- Willingness to work Monday-Friday from 9am-6pm EST, with flexibility to work beyond core hours as needed.

**Preferred Qualifications**

- Excellent verbal and written communication skills.

- Regular and reliable attendance.

- Associate's or Bachelor's degrees.

- Certified Professional Coder (CPC) certification.

**Benefits** This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

## Skills

### Required
- medical billing and coding
- claims processing
- root cause analysis
- provider engagement
- Microsoft Office products
- Microsoft Excel

### Nice to have
- excellent verbal and written communication skills
- regular and reliable attendance
- Associate's or Bachelor's degrees
- Certified Professional Coder (CPC) certification

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Source: [Apply at cvshealth.wd1.myworkdayjobs.com](https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/Field-Florida/Claim-Field-Specialist--South-Florida-_R1088643?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)