Customer Service - Case Manager
Louisville , Kentucky
November 20, 2017
Position Summary:
RxCrossroads Specialty Solutions

Position Summary:
Do you love helping people? In this dynamic role as a Case Manager, you will serve as a liaison between the patient and the pharmacy. You will monitor processing of cases for patients with specialty pharmacy vendors and home health agencies to overcome delay in turnaround times and other obstacles. You will be in regular contact with vendors. Occasionally, you will contact physician offices, payers, specialty pharmacies, and pharmaceutical company representatives. You will receive inbound calls and make outbound calls as this position is in a call center environment.

Required Qualifications:

  • High School Diploma or Equivalent

  • This position requires registration with the Kentucky Board of Pharmacy. Proof of registration is required prior to being hired .*Please note, additional education or certification is not required, only registration. Assistance will be provided.

Preferred Qualifications:
We prefer you have three years of experience in reimbursement case management, preferably in the insurance and/or pharmaceutical/biotechnology industry. In addition, you should be able to:

  • Be proficient in all aspects of reimbursement (i.e. benefit investigation, prior authorization, pre-certification)

  • Have knowledge of Medical Terminology

  • Have a deep understanding of drug reimbursement issues and claim adjudication process Navigate through the claim denial process

  • Understand HCPCS, CPT and ICD-9 coding Express ideas clearly in both written and oral communications, and carry out instructions in written, oral, or diagram form

  • Enter data correctly Show attention to detail, handle multiple tasks well, and resolve problems independently

  • Have computer skills; preferably Microsoft Word or Excel software applications

  • Calculate figures and amounts such as discounts and percentages Be adaptable to changing priorities as needed

  • Have analytical and investigation skills Meet quality and turn-around-time objectives

  • Have customer service skills; including conveying compassion for patients

  • Have a designation as a Certified Case Manager or licensed practical nurse or social worker is also preferred

High School Diploma or Equivalent

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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