Care Coordination Specialist: Medical Program Support

CVS Health; United States; Remote; USD 25,000 - 49,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking an experienced Medical Support Specialist to coordinate National Medical Excellence Program activities. You will handle inbound calls from providers and members, verify benefits and eligibility, and document information in relevant systems.

You will collaborate with clinical teams and medical directors, initiate authorizations for transplant services, and ensure confidentiality while complying with NCQA standards and company policies. 40 hours weekly, full-time.

Qualifications

• 2+ years experience as a medical assistant or equivalent
• Proficient in Microsoft Office, especially Excel
• Ability to communicate with diverse populations
• Ability to collaborate in a team environment
• Flexibility and ability to work independently

Responsibilities

• Performs intake of calls from providers or members
• Uses Aetna systems to build, research and enter member information
• Performs non-medical research including eligibility verification, COB, and benefits verification
• Maintains documentation and adheres to risk management and accreditation requirements
• Intake of calls from members or providers regarding services via telephone, fax, EDI
• Processes referrals and data entry as needed
• Collaborates with clinical team, medical directors, claims and contacting staff
• Communicates with transplant financial coordinator at the transplant center
• Initiates authorizations for kidney transplants per unit processes
• Communicates with member/provider regarding transplant services
• Build shell cases for transplant, cellular therapy, and gene therapy services and coordinate with nurse review
• Supports precertification process in compliance with laws, regulations and NCQA standards
• Communicates with Aetna nurses and medical directors when processing transactions
• Sedentary work involving sitting, talking, hearing, and keying
• Requires visual acuity for document review
• Other duties as assigned

Job description

CVS Health is seeking an experienced Medical Support Specialist to coordinate National Medical Excellence Program activities. You will handle inbound calls from providers and members, verify benefits and eligibility, and document information in relevant systems.

You will collaborate with clinical teams and medical directors, initiate authorizations for transplant services, and ensure confidentiality while complying with NCQA standards and company policies. 40 hours weekly, full-time.