Job Category: Account Management
Clinical Licensure Required : N/A
Job Type: Full Time Position Summary:
Analyze client benefit requests, determine best operational approach and perform coding. Validate coding accuracy utilizing various tools to ensure no financial impact or client/participant dissatisfaction. Responsible for meeting or exceeding turnaround time and quality standards. Research client benefit requests/issues and recommend alternative solutions to internal partners in meeting client needs.
In addition to coding, this position will also be responsible performing QA functions such as moving all plan design implementations and/or changes into a Production status upon completion of a review within tight timelines. This position may support coding and QA activities for commercial clients as well as clients with federal/state programs (such as Medicare D, Medicaid, MAPD, RDS, COB, EGWP, HealthCare Reform, etc.) Required Qualifications:
3+ years of related work experience required. Well organized with the ability to effectively prioritize work - Ownership and results driven - Customer focused - Attention to detail - Able to meet aggressive turnaround time standards/client performance guarantees coupled with excellent quality - Proficient use Microsoft Office applications, e.g. Excel, Word - Ability to effectively work within a team - Flexible in adapting to change - Demonstrated ability to analyze data and determine conclusions - Ability to learn and apply increasingly complex concepts, policies and procedures - Ability to effectively plan, prioritize, organize time and workload - Skilled in identifying and solving issues and recommending process improvements - Ability to work successfully in a deadline-oriented environment - Excellent verbal and written communication skills Preferred Qualifications:
- Project Management skills Education:
Bachelor's degree or equivalent experience. Business Overview:
CVS Caremark, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day.
As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.
Millions of times a day, close to home and across the country, we’re helping people on their path to better health.