About the position
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary As a Representative II, Operations, you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits. You will be responsible for accurately setting up cases for members, review criteria for approving requests, reaching out to providers for more information to decision requests and ensuring decisions you make are correct and timely. This is a great opportunity to initiate a career with a leading healthcare company by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, while promoting a best-in-class service experience.
Responsibilities
• Ensure accurate case setup and review of Medicare appeals cases
• Reviewing internal notes or fax requests thoroughly for pertinent information
• Providing clear, concise, and accurate documentation for case reviews
• Contacting providers to obtain additional information
• Utilize work instructions for accurate case processing
• Complying with CMS mandated timelines and department productivity and quality standards
• Acquiring and maintaining basic knowledge of relevant and changing work instructions and Medicare Part D guidance
• Participate in development discussions receiving feedback from direct supervisor
Requirements
• Ability to utilize multiple software systems, simultaneously with a 2-screen workstation setup (Windows based operations, AS400, MHK, PeopleSafe, WI database, Microsoft office applications)
• Ability to type 30 WPM or greater
• Must be able to read large volumes of information and determine importance
• Receptive to constructive feedback and flexible in adapting to change
• Flexibility with working a rotating schedule including overtime, weekends, and holidays
• Previous 6 months experience in Managed Care/PBM environment
• High School Diploma or equivalent GED
Nice-to-haves
• Excellent oral and written communication skills
• Ability to multi-task, prioritize, and manage time effectively in a fast-paced, highly regulated environment
Benefits
• medical
• dental
• vision coverage
• paid time off
• retirement savings options
• wellness programs
• other resources, based on eligibility
• CVS Health bonus, commission or short-term incentive program