Health Intake & Appeals Coordinator

CVS Health; West Virginia; Sur place; USD 23 000 - 39 000; Plein temps

Résumé du poste

CVS Health is seeking an Intake Coordinator to review, research, and enter grievance and appeal cases within one business day of receipt. You will monitor multiple intake sources—call tracking, fax, email, and mail—and appropriately prioritize requests, while handling provider and member grievances and appeals.

The role requires attention to detail, strong organizational skills, and the ability to adapt to changing procedures and workflows.

Qualifications

• 2+ years of related experience.
• Working knowledge of problem solving and decision making.
• Critical thinking skills.
• Data entry and grievance/appeals experience.
• Medicare/Medicaid experience preferred.
• Intake experience and health insurance knowledge preferred.

Responsabilités

• Review, research, and enter grievance and appeal cases within one business day of receipt.
• Monitor intake sources (call tracking, fax, email, and mail) and prioritize incoming requests.
• Intake various case types: member appeals (pre-service), member grievances, provider grievances, provider/claim appeals (post-service).
• Review information to determine appropriate case type and processing requirements.
• Manage cases with varying turnaround times and requirements based on state, plan, and case type.
• Maintain organization to ensure urgent and expedited requests are handled timely.
• Partner with QA to ensure cases are entered accurately with complete information.
• Respond to QA questions and seek clarification when needed.
• Attend weekly team meetings with Intake Coordinators, analysts, QA, managers, and project managers.
• Adapt quickly to changing procedures and workflows while maintaining accuracy and productivity.

Connaissances

Data entry

Grievance and appeals experience

Critical thinking

Problem solving

Decision making

Formation

High School Diploma or equivalent

Description du poste

CVS Health is seeking an Intake Coordinator to review, research, and enter grievance and appeal cases within one business day of receipt. You will monitor multiple intake sources—call tracking, fax, email, and mail—and appropriately prioritize requests, while handling provider and member grievances and appeals.

The role requires attention to detail, strong organizational skills, and the ability to adapt to changing procedures and workflows.