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Job Description
Job Description
As a Sr. Coordinator within the Medicare D Premium Billing group, Good Cause, this individual has shared responsibility over all Good Cause Requests received via email, hard copy mail or through our Resolution Management system. All cases must be looked at and determined Favorable or Unfavorable. Case Notes must be written with strict attention to detail of Who, What, Where and When, Confirming letters based on final outcome of Good Cause Determination must be sent, Reinstatement of member when applicable allowing for Access to Care and final RPC submission, all within the strict confines of CMS guidance and time frames.
The Sr. Coordinator must process extensive addional research to determine if a request is even a good cause request and respond. If enough information was not reported from the Care Reps. The call must be pulled and relistened to or an outbound call to the member for additional questions. Reports, Metrics and Letters are processed daily within strict time lines.
Outbound call campaigns to our members are coordinated through a third party vendor and files must be confirmed daily for the vendor along with follow up reports on the results of the outbound campaigns. This person will also check all database trackers that help to identify any missed requests, tasks, processes or outbound letters.
The Sr. Coordinator will interact cross-functionally with other internal/ external business partners and vendors as needed must have a high level of understanding for all Medicare Part D processes. This role will often need to communicate with multiple levels within the organization verbally or via written communication. As a Sr. Coordinator, this person is expected to identify any new processes and update all work instructions. Yearly, work instructions are confirmed and checked for accuracy.
Required Qualifications
1 or more years Customer Service experience.
1 or more years of experience with Microsoft Office applications either academically or professionally.
Preferred Qualifications
Knowledge of:
* Medicare D or other highly regulated government programs is a plus.
Skill in:
* Demonstrated proficiency in Microsoft Excel and Access.
* Experience in finance, billing, or a related field, with an emphasis on AR, billing, payment application, databases, or reconciliation.
* Outstanding written and oral communication and interpersonal skills.
* Experience with problem solving technical issues & process improvement initiatives.
Ability To:
* Ability to pay close attention to detail and be able to work successfully in the highly regulated environment of Medicare Part D.
* Ability to respond in a positive, proactive, and timely manner regarding potential account reconciliation issues or discrepancies.
* Demonstrated ability to research & problem solve operational/financial issues.
Education
High School Diploma or General Equivalent Development (GED)
Business Overview
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
As a Sr. Coordinator within the Medicare D Premium Billing group, Good Cause, this individual has shared responsibility over all Good Cause Requests received via email, hard copy mail or through our Resolution Management system. All cases must be looked at and determined Favorable or Unfavorable. Case Notes must be written with strict attention to detail of Who, What, Where and When, Confirming letters based on final outcome of Good Cause Determination must be sent, Reinstatement of member when applicable allowing for Access to Care and final RPC submission, all within the strict confines of CMS guidance and time frames.
The Sr. Coordinator must process extensive addional research to determine if a request is even a good cause request and respond. If enough information was not reported from the Care Reps. The call must be pulled and relistened to or an outbound call to the member for additional questions. Reports, Metrics and Letters are processed daily within strict time lines.
Outbound call campaigns to our members are coordinated through a third party vendor and files must be confirmed daily for the vendor along with follow up reports on the results of the outbound campaigns. This person will also check all database trackers that help to identify any missed requests, tasks, processes or outbound letters.
The Sr. Coordinator will interact cross-functionally with other internal/ external business partners and vendors as needed must have a high level of understanding for all Medicare Part D processes. This role will often need to communicate with multiple levels within the organization verbally or via written communication. As a Sr. Coordinator, this person is expected to identify any new processes and update all work instructions. Yearly, work instructions are confirmed and checked for accuracy.
Required Qualifications
1 or more years Customer Service experience.
1 or more years of experience with Microsoft Office applications either academically or professionally.
Preferred Qualifications
Knowledge of:
* Medicare D or other highly regulated government programs is a plus.
Skill in:
* Demonstrated proficiency in Microsoft Excel and Access.
* Experience in finance, billing, or a related field, with an emphasis on AR, billing, payment application, databases, or reconciliation.
* Outstanding written and oral communication and interpersonal skills.
* Experience with problem solving technical issues & process improvement initiatives.
Ability To:
* Ability to pay close attention to detail and be able to work successfully in the highly regulated environment of Medicare Part D.
* Ability to respond in a positive, proactive, and timely manner regarding potential account reconciliation issues or discrepancies.
* Demonstrated ability to research & problem solve operational/financial issues.
Education
High School Diploma or General Equivalent Development (GED)
Business Overview
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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