Health Intake & Appeals Specialist

CVS Health; South Dakota; Vor Ort; USD 23.000 - 39.000; Vollzeit

Zusammenfassung

CVS Health is seeking an Intake Coordinator to review, research, and enter grievance and appeal cases promptly, while monitoring multiple intake sources such as call tracking, fax, email, and mail. You will prioritize requests and ensure accuracy, working closely with QA and team members.

The role requires strong data entry, problem solving, critical thinking, and 2+ years of related experience, with a 40-hour work week and a competitive benefits package.

Qualifikationen

• 2+ years of related experience
• Data entry and grievance/appeals experience
• Critical thinking skills
• Problem solving and decision making abilities

Aufgaben

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

Kenntnisse

2+ years of related experience

Data entry

Grievance and appeals experience

Critical thinking

Problem solving

Decision making

Ausbildung

High School Diploma or equivalent

Jobbeschreibung

CVS Health is seeking an Intake Coordinator to review, research, and enter grievance and appeal cases promptly, while monitoring multiple intake sources such as call tracking, fax, email, and mail. You will prioritize requests and ensure accuracy, working closely with QA and team members.

The role requires strong data entry, problem solving, critical thinking, and 2+ years of related experience, with a 40-hour work week and a competitive benefits package.