Job Description
-Responsible for initial review and triage of claims tasked
for review.
-Determines coverage, verifies eligibility, identifies and
redirects misdirects
-Responsible for prepping the authorization in the system
and triage cases to medical staff for review.
-Organized and prioritizes work to meet regulatory and
claim turn-around times
-Promotes communication, both internally and externally to
enhance effectiveness of medical management services
and health care team.
-Performs non-medical research and support
-Adheres to Compliance with PM Policies and Regulatory
Standards.
-Maintains accurate and complete documentation of
required information that meets risk management,
regulatory, and accreditation requirements.
-Protects the confidentiality of member information and
adheres to company policies regarding confidentiality.
-Assist in the research and resolution of claims payment
issues.
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Pay Range
The typical pay range for this role is:
Minimum: 18.50
Maximum: 34.60
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.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit
Required Qualifications
-1-2 years experience as a medical assistant, office
assistant or claim processor
Effective communication, telephonic and organization
skills. Familiarity with basic medical terminology and
concepts used in care management.
-Strong customer service skills to coordinate service
delivery including attention to customers, sensitivity to
issues, proactive identification and resolution of issues to
promote positive outcomes for members.
-Computer literacy in order to navigate through
internal/external computer systems, including Excel and
Microsoft Word.
-Ability to effectively participate in a multi-disciplinary team
including internal and external participants.
-Benefits Management – Understanding Clinical Impacts,
General Business – Applying Reasoned Judgment
-Claim – Payment management, Claim – Policies &
procedures, Clinical / Medical – General Management
Preferred Qualifications
-2-4 years experience as a medical assistant, office
assistant or claim processor
-ATV, ASD, MedCompass
Education
-High School Diploma or G.E.D
Business Overview
Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose.