Transplant Care Coordination Specialist

CVS Health; Charlotte (NC); Remote; USD 25,000 - 49,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health in Charlotte, NC seeks a Medical Administrative role to handle inbound calls from members and providers, perform eligibility checks, verify benefits, and process referrals and authorizations for transplant services. You will work with the clinical team to ensure accurate documentation and compliance.

The role requires 2+ years in medical office support, strong Excel skills, and the ability to collaborate across teams. A comprehensive benefits package and bonus eligibility are offered.

Qualifications

• 2+ years’ experience as a medical assistant, office assistant or other clinical/equivalent experience.
• Computer skills, including Microsoft Office Suite (Specifically Excel)
• Ability to communicate with diverse populations
• Ability to collaborate with and work in a team environment
• Flexibility and ability to work independently

Responsibilities

• Intake of calls from providers or members.
• Utilizes Aetna Systems to build, research and enter member information in applicable system.
• Performs non-medical research including eligibility verification, COB, and benefits verification.
• Maintains accurate and complete documentation of required information and meets regulatory requirements.
• Intake of calls from members or providers regarding services via telephone, fax, EDI.
• Processing referrals, making outreach calls, entering data.
• Collaborates with the clinical team, medical directors, claims and contacting staff.
• Communicates with transplant financial coordinator at the transplant center.
• Initiates authorizations regarding kidney transplants per unit processes.
• Communicates with member or provider regarding transplant services.
• Build shell cases for transplant, cellular therapy, and gene therapy services and route to nurse review.
• Promotes internal and external communication to enhance medical management services.
• Protects confidentiality of member information and adheres to policies.
• Supports precertification process in compliance with laws and NCQA standards.
• Communicates with Aetna Nurses and Medical Directors when processing transactions.
• Sedentary work with significant sitting and keyboarding.
• Requires visual acuity for close inspection of documents.
• Other duties as assigned.

Skills

Medical assisting

Microsoft Excel

Communication

Teamwork

Independence

Education

High School Diploma or GED

Associate Degree Preferred

Tools

MedCompass

HRP

ASD

CEC

ATV

Job description

CVS Health in Charlotte, NC seeks a Medical Administrative role to handle inbound calls from members and providers, perform eligibility checks, verify benefits, and process referrals and authorizations for transplant services. You will work with the clinical team to ensure accurate documentation and compliance.

The role requires 2+ years in medical office support, strong Excel skills, and the ability to collaborate across teams. A comprehensive benefits package and bonus eligibility are offered.