Analyst, Audit Support (CGSO)
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What you'll do
- Supporting Medicare, Commercial, and Medicaid clients that delegate Prior Authorizations, Organization Determinations, Coverage Determinations and Appeals to CVS Caremark to ensure flawless audit performance.
- Ensuring our health plan clients receive accurate, consistent, and timely documentation/files for all audit-related activities by understanding CMS guidance and business requirements.
- Various assignments that require demonstrated urgency and the ability to meet set timelines.
- Projecting a professional business image through internal communication with various departments including but not limited to the Client Audit Team, Account Management Team, and the Reporting Teams.
What they're looking for
- 3 plus years prior experience with PBM - Commercial and Medicare
Nice to have
- Proficiency with Excel, Word and Adobe Acrobat Pro or CutePDF Pro.
- Strong MedHOK and CAS system knowledge preferred.
- Motivation, presentation skills, and flexibility are required.
- Ability to meet strict deadlines.
- Proven capability to work with people at all levels of an organization.
- Exceptional communication skills (oral and written).
- Knowledge of Medicare Coverage Determination and Appeals activities or Commercial activities preferred.
- Ability to work across boundaries to achieve goals.
Summarised by NextRaise from the employer’s description, which follows in full below.
Full description from employer
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
The Analyst on the Clinical and Government Services Operations Audit Support team is responsible for supporting Medicare, Commercial, and Medicaid clients that delegate Prior Authorizations, Organization Determinations, Coverage Determinations and Appeals to CVS Caremark to ensure flawless audit performance. He/she will demonstrate a focus that is committed to ensuring our health plan clients receive accurate, consistent, and timely documentation/files for all audit-related activities by understanding CMS guidance and business requirements.
The Analyst is responsible for various assignments that require demonstrated urgency and the ability to meet set timelines. He/she will have the opportunity to project a professional business image through internal communication with various departments including but not limited to the Client Audit Team, Account Management Team, and the Reporting Teams.
The Analyst will show a high level of attention to detail, verbal and written communications skills, and the ability to think critically.
Required Qualifications
- 3 plus years prior experience with PBM - Commercial and Medicare
Preferred Qualifications
- Proficiency with Excel, Word and Adobe Acrobat Pro or CutePDF Pro.
- Strong MedHOK and CAS system knowledge preferred.
- Motivation, presentation skills, and flexibility are required.
- Ability to meet strict deadlines.
- Proven capability to work with people at all levels of an organization.
- Exceptional communication skills (oral and written).
- Knowledge of Medicare Coverage Determination and Appeals activities or Commercial activities preferred.
- Ability to work across boundaries to achieve goals.
- Self directed with proven ability to manage and prioritize multiple projects simultaneously and meet deadlines.
- Energetic and highly motivated to provide exceptional client support and service.
- Bachelor's Degree
Education
High School diploma or equivalent GED
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$43,888.00 - $85,068.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Company
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