Medical Claim Analyst

CVS Health•Work At Home-Virginia, VA

1d•$19 - $39

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

Effective communication, telephonic and organization skills.
Familiarity with basic medical terminology and concepts used in care .
Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members.
Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word

Nice To Haves

2-4 years experience as a medical assistant, office assistant or claim processor
CEC/GPS, or MedCompass

Responsibilities

Responsible for initial review and triage of claims tasked for review.
Determines coverage, verifies eligibility, identifies and redirects misdirects
Responsible for prepping the authorization in the system and triage cases to medical staff for review.
Organized and prioritizes work to meet regulatory and claim turn-around times
Promotes communication, both internally and externally to enhance effectiveness of medical management services and health care team.
Performs non-medical research and support
Adheres to Compliance with PM Policies and Regulatory Standards.
Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
Assist in the research and resolution of claims payment issue