Sr Coordinator, Data Administration

Company: CVS Pharmacy
Location: Austin
Posted on: May 25, 2023

Job Description:

Job DescriptionWe have an exciting opportunity on the Pharmacy Coordination of Benefits (COB) team for a qualified individual to use and develop Aetna Core Competencies while contributing to our team and Aetna's success. This position involves research and resolution of Pharmacy COB inquiries; collecting and analyzing data to make order of benefit determinations; identifying and reacting to trends; and collaboration with a variety of internal and external areas. Outbound calls to other insurance companies and CMS (Centers for Medicare & Medicaid Services); completing internal quality audits, working member issues and facilitate any required staff training. Provide reporting and critical data elements to the leadership team as needed and any special projects are also a routine part of the job. Working independently is critical to the success of this role, as well as working collaboratively with the rest of the team.Pay RangeThe typical pay range for this role is:Minimum: 18.50Maximum: 33.65Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications 3-5 years of Coordination of Benefits experience Working knowledge of Microsoft Office products (Word, Excel, MS Access, PowerPoint, Outlook, Project) Health care industry experience Minimum 1 yr experience of working with Claims Data Receive, triage, research and resolve Pharmacy COB inquiries in an accurate and timely mannerReview, collect and resolve conflicting, missing or inaccurate pharmacy benefit information via telephone, email and written municate clearly and concisely with internal customer service representatives, plan sponsor liaisons, other insurance providers and Medicare to collect information and resolve complex coordination of benefit issuesEffectively analyze and interpret information collected to make order of benefit determinations using Medicare Secondary Payer and NAIC (National Association of Insurance Commissioners) order of benefit determination guidelinesUpdate member files in appropriate systems to reflect accurate coordination of benefits. Use tools and queries to generate reports, analyze data, identify recovery opportunities and forward data to vendor to obtain recoveryCreate and follow detailed Policy and Procedure guidelines for all facets of job responsibilities, as neededAbility to effectively prioritize multiple assignments to meet turn-around-times while meeting or exceeding standard business practices and procedures.Focus on problem-solving and thorough resolution of complex issuesEarly identification of recurring COB issues/trends (either individual or group-wide) and ability to escalate issues/trends to appropriate level by providing clear communication accompanied by examples of the issue/trendBe open and enthusiastic to change; embrace new technology/processes and serve as the Subject Matter Expert (SME) for the COB team.Preferred Qualifications Detail oriented Excellent time management skills Experience in data research and analysis Excellent verbal and written communication skills Working knowledge of Salesforce and RxClaimEducationHigh School Diploma or higherBusiness OverviewBring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. 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. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Keywords: CVS Pharmacy, Austin , Sr Coordinator, Data Administration, Other , Austin, Texas