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

-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 issue

REQUIRED QUALIFICATIONS

Effective communication, telephonic and organization skills. Familiarity with basic medical terminology and concepts used in care . -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

PREFERRED QUALIFICATIONS

• 2-4 years experience as a medical assistant, office assistant or claim processor
• ATV, HRP, or MedCompass
  Education High School Diploma or G.E.D

Please refer the Job description for details