Job Details

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

This role will review qualification requirements for Medicare Part B patients focusing on Specialty infusion therapies. Other responsibilities include creating Medicare forms and qualification packets, collaborating with the Medicare Billing and audit teams, and conducting education sessions with Sales and Referral sources. Other responsibilities include, but are not limited to:

• Review clinical documentation for qualification criteria as outlined by Medicare Part B guidelines for Medicare Part B and Managed Medicare payors

• Document clinical review in Epic, to include billing instructions and the use of appropriate billing modifiers or specific reason for non-coverage

• Prepare Medicare Part B and Managed Medicare payer qualification packets, and upload into Epic document repository

• Create Medicare ABN form, to include specific verbiage for non-coverage

• Collaborate with Billing team on Medicare Part B infusion claim edits

• Conduct continued medical necessity reviews for long term, cyclical therapies

• Conduct education sessions with Sales Liaisons, to include preparation of educational materials

• Participate with Sales and Referral sources in qualification discussions

• Collaborate with CVS Specialty Pharmacy as needed

• Review Medicare medical necessity denials

• Submit documentation of continued medical need and other supporting information into Medicare appeals portal

• Understanding and staying updated on Medicare Fee for Service LCDs and Policy articles

As a Senior you help develop the team utilizing CVS's core values: collaborating as a subject matter expert, providing guidance for issue resolution, supporting new hires through side-by-side training, creating and presenting job aids, assisting with assigned projects, driving recognition and other organizational support as needed.

Required Qualifications

• 1+ years of experience in a professional environment; beginner level experience working in Excel, Outlook, and Word.

Preferred Qualifications

• Home infusion or durable medical equipment (DME) experience

• Strong attention to detail with a sense of urgency

• Customer service skills

• Ability to work in a team environment

• Experience with medical billing or collections or experience with accounts payable (AP) or accounts receivable (AR)

• Experience with healthcare reimbursement systems

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:

$18.50 - $38.82

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

We anticipate the application window for this opening will close on: 10/10/2025

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

We are an equal opportunity and affirmative action employer. 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.