Complaint & Appeals Analyst (Must reside in Arizona)

CVS Health•Work At Home-Arizona, AZ

1d•$21 - $41•Onsite

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Requirements

1-2 years of Behavioral Health experience.
Experience in customer interactions and review of health-related materials.
Good knowledge of Medicare, AHCCCS, and healthcare industry.
Must reside in Arizona.

Nice To Haves

Strong reading and writing skills, ensuring documents meet standards and are accurate.
Excellent organizational skills.
Previous experience with customer interactions and review of health-related materials.
Strong interpersonal skills.
Attention to detail.
Self-motivated and able to work independently.

Responsibilities

Independently conduct mediation conferences to solve behavioral health concerns, investigate behavioral health human rights violations ensuring compliance with Federal and/or State regulations and the Arizona Administrative Code.
Responsible for compliance with policies of all applicable Federal and/or State government agencies, including but not limited to Center for Medicare and Medicaid Services (CMS) as well as the Arizona Health Care Cost Containment System (AHCCCS).
Researches and translates organizational policy into intelligent and logically written investigation reports and decision letters.
Manages timelines to ensure state guidelines are met and investigations are timely.
May create and communicate grievance and appeal policies, procedures, and outcomes with all levels of the organization.
Successfully works across functions, teams, providers, and community agencies on investigations to resolve escalated cases.
Demonstrates strong letter writing skills; drafts individual letters based on current findings, regulations and legislation.