Note: The job is a remote job and is open to candidates in USA. CVS Health is a health care company focused on creating a connected, convenient, and compassionate health experience. The Legal Case Manager reviews, researches, validates, and processes requests for member Protected Health Information, ensuring compliance with HIPAA, state privacy laws, regulatory requirements, and organizational policies before records are disclosed.
Responsibilities
- Review, research, and process requests for member claims records involving Protected Health Information (PHI), ensuring compliance with HIPAA, state privacy laws, company policies, and regulatory requirements
- Process and fulfill requests submitted to Aetna seeking access to member Protected Health Information (PHI), ensuring all legal, regulatory, privacy, and authorization requirements have been satisfied before records are disclosed
- Review and validate request documentation to determine eligibility for disclosure and confirm compliance with applicable federal and state regulations
- Manage and process requests received through: + Subpoenas and court orders + Law enforcement requests and demands + Regulatory agency inquiries and requests + Legal Access requests + Member and provider authorizations + Personal representative requests + Other legally permitted disclosures of Protected Health Information
- Research and resolve complex or non-routine member rights, disclosure, and privacy requests, escalating matters requiring legal, compliance, or privacy review
- Ensure confidentiality and security of sensitive member information while adhering to established policies, procedures, and internal controls
Skills
- Working knowledge of problem solving and decision making skills
- 2-5+ years' work experience with Protected Health Information (PHI)
- Excellent verbal and written communication skills
- High School Diploma or Equivalent Experience (REQUIRED)
- Working knowledge of HIPAA Privacy Rule requirements
- Experience reviewing and interpreting legal documents, subpoenas, court orders, authorizations, and regulatory correspondence
Benefits
- This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
- Medical, dental, and vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources, based on eligibility
Company Overview