Prior Authorization and Appeals Coordinator
San Antonio , Texas
October 16, 2017
Position Summary:
Clinical Services Coordinator will be responsible for performing non-clinical activities and functions in accordance with policies and procedures, under the supervision of the Clinical Supervisor. Responsible for reviewing and maintaining
compliance with ERISA, CMS, Medicaid, and client specific requirements. Works as part of the team to meet business unit objectives.

This position will be responsible for ensuring all member and physician communications involving the PA process are sent successfully and documented. Communications includes faxes, manual outbound calls, mailing of letters, and IVR calls.

1.) Monitor a queue of all unsuccessful faxes. Depending on state regulations, a manual outbound call is made to the physician’s office to inform of the decision of their PA/Appeal, and documentation is added to the case. Once all necessary calls are completed, all failed faxes are sent to the mail file

2.) Files of letters are pulled multiple times a day, saved, and then notification is sent to the print room to complete the printing and mailings. Once the mailing is completed, notification is provided, and then documentation must be made within PA system for tracking purposes.

3.) IVR extracts are pulled directly from PA tool, some manipulation of the file layout is made, then research is completed to ensure all member phone numbers are in the file. Once the file is complete, the file is then uploaded on our vendor’s site. Once confirmation is received that all calls were completed, the file is uploaded so documentation is added to the PA tool.

4.) And any other tasks identified by leadership involving communications

This position will not start until December 4th 2017


Required Qualifications:
1+ years experience in Data Entry.

Preferred Qualifications:
1-year healthcare industry related experience (hospital, managed care, physician office, PBM etc).
Proficient in Windows applications (Word and Excel).
Problem solving skills, analytical ability.
Strong written communication and interpersonal skills.
Minimum 25-30 WPM.
Detail oriented with excellent organizational skills.
Preferred knowledge of prescription drug products, dosage forms and usage.
Medical / pharmacy terminology background.

HS Diploma or GED required

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 AA EEO CVS Health

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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