Senior Manager Adjudication, Long Term Care

CVS Health - Des Plaines, IL3.4

Full-timeEstimated: $42,000 - $59,000 a year
Responsible for all third party pharmacy billing activities within assigned region. Regional Billing Manager will promote strong billing practices, ensure compliance with all policy and procedures and be directly responsible for overall financial performance. The Regional Billing Manager works closely with Accounting, Pharmacy Operations and other areas of the billing department.

Key Responsibilities:
  • Manage prospective and retrospective claim resolution through team development and delegation of duties.
  • Staff management to ensure all operational areas are supported and work queues are sufficiently managed to meet claim clear times and medication delivery expectations. Influences employee messaging and communication around change initiatives.
  • Monitor compliance of claim resolution activity and ensure strict financial controls.
  • Partner with regional pharmacy operations staff to align billing initiatives to operational goals. Viewed as influential partner. Build credible relationships with management team, business partners.
  • Identify process improvement opportunities and contribute to departments best practice program.
  • Ensure all billing and divisional financial goals are met.
Management Responsibilities:
  • Responsible for providing employees with timely, candid and constructive feedback; developing employees to their full potential and providing challenging opportunities that enhance employee career growth; developing the appropriate talent pool to ensure adequate bench strength and succession planning; recognizing and rewarding employees for accomplishments.
  • Oversee strict compliance with all billing policy and procedures, state and federal regulations.
  • Create monthly and quarterly management reports.
  • Able to work independently with general direction.
  • Communication required to all levels including associates, management and executive management.
Required Qualifications
  • 2 - 5+ years in pharmacy industry
  • Proven track record in existing operations management role overseeing 15 + associates and multiple pharmacy locations.
  • Incumbent must show an ability to successfully collaborate with and influence management and peers to support growth and financial goals.
  • A sense of urgency and drive for results coupled with an ability to partner effectively with all levels of management is critical.
  • Problem solving, prioritization, coaching, trust-building, and analytical skills.
  • Excellent interpersonal, verbal and written communication skills.
  • Ability to interact with all organizational levels.
  • Travel required.
Preferred Qualifications
  • Preference will be given to internal candidate with proven record of success.
  • College degree.
High School Diploma or equivalent
College Degree preferred

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.

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