Advisor- Quality Medicare Part D

  • Company: CVS Health
  • Location: Scottsdale, Arizona
  • Posted: October 13, 2017
  • Reference ID: 698864BR
Position Summary:
CVS Health, a Fortune 7 Company, has an outstanding opportunity for an Advisor Quality Medicare Part D. This role will base out of our Scottsdale location.

In this role you will manage the activities and 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. 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. 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 with daily claim review.

Required Qualifications:
*3 or more years relevant work experience; strong Plan design, claim adjudication and Medicare Part D experience required.

*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 complex mathematical calculations and how plan design can impact CVS Health's ability to meet CMS guidelines.

*Ability to drive to solution quickly cross-functionally to meet CMS timeframes.

*Knowledge of Prescription Benefit Management industry.

*Highly proficient in analyzing complex claim transactions and systems; specifically RxClaim.

*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).

*Excellent presentation skills - ability to present and communicate effectively to internal business partners and external clients.

*Excellent organizational and time management skills.

*Excellent interpersonal and collaborative skills.

*Able to work in fast paced and changing work environment with quick turnaround.

*Able to work collaboratively with people in a team environment.

*Able to work independently.

*Ability to meet deadlines with a variety of responsibilities.

*Ability to work effectively with multiple functional areas.

*Ability to exercise professional judgement in analyzing and resolving client issues.

*Ability to creatively solve problems when dealing with a variety of variables in situations where standard resolutions do not exist .

* Ability to thoroughly explain impacting results to internal and external clients.

Preferred Qualifications:
*Strong RxClaim benefits coding experience preferred.

Bachelor's degree. Will consider combination of years relevant work experience.

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 EEO AA CVS Health

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:

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