Coordinator – CVS Remote Jobs

Job Type: Coordinator from home
Location: California work from home
Company: CVS Health

Responsible for the management of Fast Track Appeals for Medicare products, which may contain multiple issues and may necessitate coordination of responses from multiple business units and outside entities. Ensure that Medicare Fast Track Appeal requests are handled in a timely and customer-focused manner. Identify and report on emerging trends and issues, as well as recommend solutions.

Responsibilities:

• Investigate incoming Medicare Fast Track appeals to determine if they are appropriate for the unit based on published business responsibilities. Determine the appropriate resource and redirect inappropriate work items that do not meet the appeal criteria. Identify and research all Fast Track appeal components for all products and services.
• Completed complaints/appeals are routed to the appropriate subject matter expert within another business unit(s) for resolution response content to be included in the final resolution response.
• Coordination of all Fast Track appeal components, including all required communication to member/provider for final resolution and closure.
• Serve as a technical resource to colleagues on letter content, state or federal regulatory language, complaint/appeal triaging, and other situations that require a higher level of expertise.
• Identifies trends and emerging issues, reports on them, and provides feedback on potential solutions. Follow up to ensure that the Fast Track appeal is handled within the timeframe established to meet company and regulatory requirements.
• As assigned, serve as a single point of contact for Fast Track appeals on behalf of members or providers.

Pay Scale

The typical salary range for this position is as follows: Minimum: 17.00 Maximum: 27.90

Please keep in mind that this range represents the average pay for all positions in the job grade in which this position is located. The actual salary offer will consider a variety of factors, including location.

Requirements:

Qualifications Required

• Experience with Medicare platforms, products, and benefits, patient management, compliance and regulatory analysis, special investigations, provider relations, customer service, or auditing is preferred.
• Experience with utilization management system research and analysis.

Qualifications Preferred

• 1-2 years of experience with Medicare platforms, products, and benefits, patient management, compliance and regulatory analysis, special investigations, provider relations, customer service, or auditing.
• Experience with utilization management system research and analysis. MedHOK, GPS, and MedCompass

Education:

• Some college education is preferred.
• High school diploma or GED equivalent.