Insurance AR Resolution Analyst, Revenue Cycle

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

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, overpayments, 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, identify and report defects as well as follow up on the resolution, and recommend and write 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 escalate 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.

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

Essential Qualifications and Functions

• 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

Required Qualifications

Knowledge of:

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

Skill in:

• 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 MicroStrategy, SQL, and other data mining tools
• Developing leadership-ready documentation and recommendations

Ability to:

• 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

Preferred Qualifications

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

Education

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

Prior Relevant Work Experience

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

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

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