Senior Coordinator, Complaint and Appeals Operations

Job not on LinkedIn

🔥 29 minutes ago

🌴 South Carolina – Remote

🌴 South Carolina – Remote

💵 $18 - $31 / hour

⏰ Full Time

🟠 Senior

⚙️ Operations

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Responsible for managing to resolution Fast Track Appeal scenarios for Medicare products • Act as a subject matter expert by providing training, coaching, or responding to complex issues • Research and resolves Fast Track Appeals as appropriate • Can identify and reroute inappropriate work items that do not meet appeal criteria • Assemble all data used in making denial determinations • Educates team mates as well as other areas on all components within member or provider/practitioner complaints/appeals for all products and services • Coordinates efforts both internally and across departments

🎯 Requirements

• Knowledge of Fast Track Appeals and includes CMS Guidelines for Fast Track Appeals • 2-3 years' experience that includes both Medicare platforms, 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. • HS Diploma, Associate's degree or equivalent experience

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • other resources, based on eligibility