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Position Summary

Responsible for managing to resolution of Fast Track Appeals for Medicare products, which may contain multiple issues and, may require coordination of responses from multiple business units and outside entities. Ensure timely, customer focused response to Medicare Fast Track Appeal requests. Identify trends and emerging issues and report and recommend solutions.

Research incoming Medicare Fast Track appeals to identify if appropriate for unit based upon published business responsibilities. Identify correct resource and reroute inappropriate work items that do not meet appeal criteria. Identify and research all components within Fast Track appeals for all products and services.

Triage incomplete components of complaints/appeals to appropriate subject matter expert within another business unit(s) for resolution response content to be included in final resolution response.

Responsible for coordination of all components of Fast Track appeals including all required communication to member/provider for final resolution and closure.

Serve as a technical resource to colleagues on letter content, state or federal regulatory language, triaging

of complaint/appeal issues, and similar situations requiring a higher level of expertise.

Identifies trends and emerging issues and reports on and gives input on potential solutions. Follow up to assure Fast Track appeal is handled within established timeframe to meet company and regulatory requirements.

Act as single point of contact for Fast Track appeals on behalf of members or providers, as assigned.

Required Qualifications

1-2 years' experience in Medicare

platforms, products, and benefits; patient management; compliance and regulatory analysis; special investigations;

provider relations; customer service or audit experience.

Experience in research and analysis of utilization management systems.

Preferred Qualifications

Knowledge in Word, MedHOK, MedCompass,QuickBase applications, Avaya System, GPS, CMS Guidelines for Fast Track Appeals

Education

2-3 years' experience that includes both Medicare platforms, products, and benefits; patient management; compliance and regulatory analysis; special investigations; provider relations; customer service or audit experience. Experience in research and analysis of utilization management systems.

Associate's degree or equivalent experience

Pay Range

The typical pay range for this role is:

$18.50 - $38.82

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)

We anticipate the application window for this opening will close on: 11/30/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.