Location: Chicago,IL, USA
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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.
Position Summary
As a PERS Rx Benefit Coding Auditor (internal title: Mgr, Implementation) for CVS Health, you will perform activities associated with pharmacy audits of PERS/CCI benefit coding for accuracy. You'll be responsible for the ensuring the overall quality of the pharmacy benefit coding setup in PERS/CCI. You'll Ensure the coding is in line with coding documents provided and state legislation requirements. You will partner with all key stakeholders (e.g. Plan Sponsor Services, Plan Coordination Consultants, Compliance, Clinical, Product and other internal business units) to proactively identify and address benefit coding errors and discrepancies ensuring customer expectations are consistently satisfied or exceeded.
Your duties will include:
* Act as the single point-of-contact for assigned Pharmacy PERS Audits.
* Identify and report benefit coding errors.
* Perform Help Desk reviews following predefined processes. Knows how to respond to any given questions presented and knows what areas to reach out to when research is needed.
* Performs post audit PERS Audit Request Audit Tracker (PARAT) following predefined process.
* Identifies gaps and recommends enhancements related to new and/or existing products, services and workflows based on broad view of the organization.
* Assists with the development of process documentation and instructions.
* Track progress of deliverables and communicates status to leader on a regular basis.
* Provide input on business plan to achieve business goals.
* Proactively and independently lead projects and understand the business implications of requested enhancements.
* Represent and support the pharmacy PERS Audit team in discussions of new product and program initiatives as it relates to PERS Audits.
* Lead meetings with other departments/internal constituents and presents subject matter materials as needed.
* Support the business by recommending appropriate actions, strategies and/or alternatives to meet business needs.
* Perform post audit PERS Audit Request Audit Tracker (PARAT) following predefined process.
To be a candidate for this role you will possess the following:
* Strong knowledge of benefit coding standards and can research standards without support.
* Strong knowledge of Salesforce.
* Strong knowledge of LAT.
* Strong knowledge of LGIT.
* Ability to work collaboratively within work teams.
* Able to handle multiple assignments/projects as the same time while ensuring completion of assignments according to established timelines.
* Independent worker with ability to handle assignments with little or no direction provided.
* Strong analytical skills and innovative problem solving abilities.
* Attention to detail and accuracy while focusing on overall project deliverables.
* Highly organized and able to quickly prioritize multiple assignments with high quality results.
* Strong interpersonal communication skills using active listening and open ended questions to encourage others' points of view to influence others to achieve best practices.
* Effective verbal and written communication skills.
* Ability to express complex concepts in a clear and concise manner.
* Ability to remain flexible yet focused during stressful situations.
Required Qualifications
* 2 years of PERS Rx Benefit Coding experience.
Preferred Qualifications
* 7 years healthcare industry experience.
* 5 years in depth knowledge of Aetna's spectrum of products, services and system capabilities.
* Project management and leadership experience.
* Experience preparing and delivering presentations.
* Experience setting up and leading meetings.
* Experience interacting with various levels of the organization to effectively influence others and achieve optimal results.
* Negotiation and conflict resolutions skills across various levels of the organization.
* In depth knowledge of department functions that is sought by others.
* Comprehensive understanding and strong association with Aetna organizations representing products, administration, operations and systems.
Education
* Bachelor's degree or equivalent experience.
Pay Range
The typical pay range for this role is:
$54,300.00 - $145,860.00
This 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.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ( PTO ) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit Benefits | CVS Health
We anticipate the application window for this opening will close on: 12/24/2024
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.