Client Benefit AnalystBookmark This
Clinical Licensure Required :N/A
Job Type:Full Time Position Summary:
As part of the Client Connect Project Team, performs coding for clients migrating from ReCap to RxClaim based on reports and lists pulled from ReCap for non-automated benefit code set up. Performs validation testing using EZ Test utilities. Review and validate testing results, resolve defects and provide feedback based on analysis. Writes and executes queries and macros to load volumes of data needed for the migration and to verify loading. Analyze client benefit requests, determine best operational approach and perform coding. Recognize when and engage SME to determine best operational approach to resolve complex benefit coding issues/errors. Validate coding accuracy utilizing various tools to ensure no financial impact or client/participant dissatisfaction. Responsible for meeting or exceeding turnaround time and quality standards. Research client benefit requests/issues and recommend alternative solutions to internal partners in meeting client needs. Trending analysis, supporting ad hoc situations and mentoring new staff. Interface with internal partners via conference calls and written communication as needed to complete all tasks and meet client needs/requirements. Required Qualifications:
*MUST be Analyst level experienced RxClaim plan benefits coder, with advanced knowledge of custom coding setups in RxClaim * 3-5 years of relevant work experience. * May include retail and/or PBM pharmacy technician experience that demonstrates progressive upward growth. Preferred Qualifications:
* MED D experience a plus. * Experience running manual claims, test claims, mock adjudication, EZ Test and Testsuite * Well organized with the ability to effectively and independently prioritize work * Ownership and results driven * Customer focused * Attention to detail * Able to meet aggressive turnaround time standards/client performance guarantees coupled with excellent quality * Proficient use Microsoft Office applications, e.g. Excel, Word * Ability to effectively work within a team environment * Flexible in adapting to change * Demonstrated ability to analyze data, verify accuracy and determine conclusions * Ability to learn and apply increasingly complex concepts, policies and procedures * Ability to effectively plan, prioritize, organize time and workload to complete assigned work within specified timeframes * Skilled in identifying and solving issues and recommending process improvements * Ability to work successfully in a deadline-oriented environment * Excellent verbal and written communication skills * Benefit design experience and understanding of system functionality and limitations. * Ability to notice trends, perform root cause analysis, and champion solutions. * Exposure to user acceptance testing, client acceptance testing, and certification testing * Thorough understanding of RxClaim platform/system applications/products * Proficient in analyzing and executing clinical and non-clinical client work requests * Knowledge of healthcare industry Education:
Bachelor's degree or 2 years of relevant work experience in lieu of every year of college education missing. Business Overview:
CVS Caremark, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units - MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.