Insurance AR Resolution Analyst, Revenue Cycle

Position Overview

CVS Health Third-Party Revenue Cycle Management (RCM), supporting CVS Retail pharmacies, has an opportunity for a full-time Insurance AR Resolution Analyst. As an RCM Analyst, you will perform advanced, payer-level analysis to support Third Party Account Management in maximizing collections, reducing bad debt, and ensuring compliance with federal, state, and CVS Health requirements.

This role focuses on identifying systemic drivers of payer exceptions, over payments, liabilities, and remittance issues through trend analysis, root cause diagnosis, and data validation. The analyst produces clear, leadership-ready insights and recommendations that drive short- and long- term operational improvements across Commercial and Medicaid payers.

In addition to supporting the Pharmacy Account Management team, this analyst will coordinate files for write offs and will work closely with our system partners by attending requirement meetings, identifying and reporting defects as well as following up on the resolution, and recommending and writing requests to streamline current processes.

Success in this role requires analytical thinking, attention to detail, and the ability to follow established procedures while exercising judgement to escape or recommend resolution paths as appropriate. As part of the account management team, you will work in a fast paced and team focused environment to ensure timely and accurate AR resolution.

• Apply advanced analytical and statistical techniques to identify root causes of Third-Party payer issues
• Validate data accuracy and completeness using SQL and internal reporting tools
• Translate complex findings into clear, actionable recommendations for leadership
• Collaborate cross-functionally to prevent recurrence of payer issues
• Maintain regular and predictable attendance and perform additional duties within role scope

• Knowledge of Third Party Revenue Cycle operations, payer behavior, and liability resolution
• Knowledge of Commercial and Medicaid payer environments

• Advanced analytical and root cause diagnosis techniques
• Solid working knowledge of all MS Operating Systems and MS Office applications (MS Word, Excel, Access, PowerPoint), and process mapping software such as Microsoft Project and Visio
• SQL and data-mining tools to validate and reconcile financial data
• Familiarity with Micro Strategy, SQL, and other data mining tools
• Developing leadership-ready documentation and recommendations

• Independently evaluate complex problems and recommend effective solutions
• Influence decisions through data-driven insights rather than authority
• Prioritize and organize work to accurately complete projects or assignments on schedule
• Work individually or with a team to systematically identify and define problems, evaluate alternatives and implement practical, cost-effective solutions
• Frame recommendations and formally present them to management
• Work with sensitive financial and patient data in compliance with HIPAA
• Maintain composure and perform job duties/responsibilities when confronted with stressful situations
• Maintain excellent verbal and written communication skills and the ability to interact professionally with a diverse group
  -directors, managers, colleagues, and external entities
• Work in strict confidence, always ensuring the confidentiality of the patient and medical and financial records, in compliance with company and HIPAA Privacy guidelines
• Operate effectively in ambiguous or evolving environments

• Accounts receivable or payer-facing experience
• Experience supporting system enhancements or process improvement initiatives
• Strong presentation and stakeholder communication skills

• Required:
  
  High School Diploma or General Equivalent Development (GED)
• Preferred:
  Bachelor Degree

• Preferred 3 to 5 years of analytics experience. 2+ years required.

40

Full time

$43,888.00 - $

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.

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