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Quality Medicare Part D - Advisor

at CVS Health

Posted: 4/10/2019
Job Reference #: 925940BR
Keywords: management

Job Description

Job Title :
Quality Medicare Part D - Advisor
Job ID :
925940BR
Location :
AZ - Scottsdale
Street Address :
9501 E Shea Blvd
Category :
Medicare
Description :
Job Description
Ready to take your Medicare Part D skills to the next level with a Fortune 7 company? Check out this new opportunity with CVS Health.

The Quality Medicare Part D Advisor position manages the activities and provides subject matter expertise in support of Medicare Part D claim adjudication analysis for paid and rejected claims. Emphasis on complex claims adjudication such as clinical programs, transition fill, drug coverage, RxClaim benefits coding and client's benefit plan designs. This position will have the following responsibilities to support CVS Health's organization:

*Responsible for analyzing complex claims to determine claims adjudication appropriateness aligned to Center of Medicare and Medicaid Services (CMS) requirements.
*Resolve any adjudication discrepancies through working with various departments until resolved. This position requires a strategic end to end view of claim adjudication, pinpointing compliance risks and managing resolution through completion. 3) Participate in client/consultant meetings and/or external audits to explain claim adjudication trends and processes.
*Review, interpret, analyze and fully understand CMS guidance related to claim adjudication and incorporate into the process.
*Mentor and assist Analysts and Sr Analysts

Required Qualifications
*3 or more years experience with plan design, claim adjudication and Medicare Part D.
*Ability to work with and influence crossfunctionally to implement new requirements effectively - very strong interpersonal skills required. Strong critical thinking skills required. Requires the ability to understand how plan design can impact Caremark's ability to meet CMS guidelines.
*Ability to drive to solution quickly cross-functionally to meet CMS timeframes.
Knowledge of Microsoft Office Suite with a focus on Excel, Powerpoint, Word, Outlook or Lotus Notes and Web applications
*Excellent verbal and written communication skills (be comfortable articulating complex issues to all levels of management and potentially clients).

Preferred Qualifications
*PBM experience

Education
*Bachelor's degree required. An equivalent combination of education and experience may substitute.

Business Overview
CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units - MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.

CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking Advice and Counsel

CVS Health does not require nor expect that applicants disclose their compensation history during the application, interview, and hiring process.

For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-338-5609. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. Please note that we only accept resumes via our corporate website: https://jobs.cvshealth.com/

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!