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Clinical Claims Support Technician
2 months ago
Join CVS Health in our mission to enhance health care delivery. At CVS Health, we are dedicated to providing personalized, accessible, and affordable health care solutions. Our commitment to human-centric care is reflected in our Heart At Work Behaviors, empowering our team members to contribute to a culture of innovation and transformation.
Position Overview: The Clinical Claims Support Technician plays a vital role in managing and resolving clinical claims issues, specifically focusing on Prior Authorizations and Covered Alternative Recommendations.
Key Responsibilities:
- Assist in the processing of rejected real-time claims for all pharmacies under the guidance of CIC pharmacists.
- Engage with insurance providers through phone communications.
- Collaborate with local pharmacies to ensure timely medication dispensing.
- Gather necessary information from facility staff to facilitate overrides and prior authorizations.
- Utilize online communication portals to reconcile facility responses.
- Initiate prior authorization requests and collect relevant data as directed.
- Follow up with insurance plans regarding submitted prior authorizations.
- Communicate outcomes of prior authorization requests to CIC and pharmacy staff, addressing denials appropriately.
- Update management on changes in prior authorization criteria and issues with insurance plans.
- Scan and transmit new or authorized orders to designated locations.
- Maintain detailed records of claims, activities, and outcomes as instructed.
- Review CIC reports and respond accordingly.
- Participate in cross-training for coverage of various positions within the CIC.
- Adhere to all relevant regulations, including HIPAA compliance.
- Exhibit behaviors that align with the employee code of conduct.
- Perform additional duties as assigned; responsibilities may vary by location.
Qualifications:
Required:
- Experience in the healthcare field.
- Exceptional communication and interpersonal skills.
- Flexibility in work schedule.
Preferred:
- Experience in long-term care or similar medical environments.
- Certification as a Pharmacy Technician at the state or national level.
Physical Requirements: The role may involve sitting, standing, bending, and walking throughout the day. Extended hours may be necessary, and the ability to lift up to 25 pounds occasionally is required. Visual acuity for fine print and the ability to hear normal voice sounds are essential.
Work Environment: The position is based in a climate-controlled, smoke-free internal setting.
Compensation and Benefits: CVS Health offers a competitive compensation package, including medical, dental, and vision benefits, along with a 401(k) retirement savings plan and an Employee Stock Purchase Plan. Additional perks include paid time off, holiday pay, and employee discounts at CVS stores.
Diversity and Inclusion: CVS Health is an equal opportunity employer, committed to diversity and inclusion in the workplace. We welcome applicants from all backgrounds and do not discriminate based on any characteristic protected by law.
