Sr Coordinator, Complaint & Appeals Ops Location: GA - Work from home
Remote Type: Hybrid
Time Type: Full time
Posted On: 2 Days Ago
End Date to Apply: November 30, 2024 (19 days left to apply)
Job Requisition ID: R0415817
Bring your heart to CVS Health. Every 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.
Position Summary
This position supports the daily processing of appeals in the Commercial Member Clinical Appeals (CMCA). Job functions include:
Completing appeals determination letters Intake and launching of expedited requests Updating systems Completing reporting as necessary Supporting the panel hearing process Working collaboratively with clinical support staff (Medical Directors, Nurses, Providers, etc.) Triage of faxes Movement of cases in the Complaints and Appeals Tracking System (CATS)
All work is to be handled in compliance with turnaround times and regulatory standards.
Schedule: M-F 8:30 AM - 5:00 PM local time, may include a rotational Saturday shift every 5-6 weeks as needed.
Required Qualifications Strong written and verbal communication Ability to multi-task Proficient in basic computer skills including Microsoft Office Suite Preferred Qualifications
Knowledge of appeals process/appeals experience.
Education
High School Diploma.
Pay Range
The typical pay range for this role is: $18.50 - $38.82. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography, and other relevant factors.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long-term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time, and other time off are provided consistent with relevant state law and Company policies.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws.
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