Operations Representative II - Medicare D Quality

9 hours ago

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CVS Health

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Retail • Pharmacy Benefits Management • Health Insurance • Health Care • Pharmacy

10,000+

Description

• Learning the rework queues for each line of business. • Working rework reports timely. • Researching and troubleshooting failed claims. • Adding and/or editing overrides in RxClaim. • Logging audits and errors accurately and timely. • Ability to identify trends and provide suggestions for process improvement. • Researching and correcting any issues found in the overall process. • Raising issues to Coverage Determination Clinical Pharmacists and Management team as needed. • Reading, analyzing, and interpreting general business correspondence, technical procedures, and governmental regulations. • Solving practical problems and dealing with multiple concrete variables in standardized situations. • Performing basic mathematical calculations. • Ensuring all cases are properly closed. • Ability to interpret a variety of work instructions provided through multiple mediums. • Ability to anticipate needs and resolve issues with urgency and to meet quality and production standards.

Requirements

• 2 plus years of Coverage Determination & Appeals experience. • MHK, RxClaim, and People Safe proficient. • Meeting quality and productivity metrics in current role. • 3 plus year of Coverage Determination & Appeals experience (preferred). • 1 plus year of Medicare PART B experience (preferred).

Benefits

• Full range of medical, dental, and vision benefits. • 401(k) retirement savings plan. • Employee Stock Purchase Plan. • Fully-paid term life insurance. • Short-term and long-term disability benefits. • Well-being programs. • Education assistance. • Free development courses. • CVS store discount. • Discount programs with participating partners. • Paid Time Off (PTO) or vacation pay. • Paid holidays throughout the calendar year.