Vacancy expired!
Job DescriptionResponsible for managing to resolution of Fast Track Appeals for Medicare products, which may contain multiple issues and, may require coordination of responses from multiple business units and outside entities. Ensure timely, customer focused response to Medicare Fast Track Appeal requests. Identify trends and emerging issues and report and recommend solutions.Research incoming Medicare Fast Track appeals to identify if appropriate for unit based upon published business responsibilities. Identify correct resource and reroute inappropriate work items that do not meet appeal criteria. Identify and research all components within Fast Track appeals for all products and services.Triage incomplete components of complaints/appeals to appropriate subject matter expert within another business unit(s) for resolution response content to be included in final resolution response.Responsible for coordination of all components of Fast Track appeals including all required communication to member/provider for final resolution and closure. Serve as a technical resource to colleagues on letter content, state or federal regulatory language, triagingof complaint/appeal issues, and similar situations requiring a higher level of expertise.Identifies trends and emerging issues and reports on and gives input on potential solutions. Follow up to assure Fast Track appeal is handled within established timeframe to meet company and regulatory requirements.Act as single point of contact for Fast Track appeals on behalf of members or providers, as assigned.Required Qualifications1-2 years' experience that includes both HMO and Medicareplatforms, products, and benefits; patient management; compliance and regulatory analysis; special investigations;provider relations; customer service or audit experience.Experience in research and analysis of utilization management systems.COVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred QualificationsN/AEducationAssociate's degree or equivalent experienceBusiness OverviewBring your heart to CVS HealthEvery 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. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
Vacancy expired!