Dec 13, 2019

Pharmacy Technician- Claims Associate FT- 1148160BR

  • Professional Diversity Network
  • Spartanburg, SC, USA
Full-Time Retail

Job Description

CVS Health

Job Description
Omnicare, Inc. is a wholly owned subsidiary of CVS Health Corporation. Directly, and through our subsidiaries, Omnicare provides a broad array of pharmacy-related services to long term care facilities and to other customers in the health care environment. While senior care has long been an Omnicare specialty, we also serve other targeted populations.

Do you love working in a fast-paced and dynamic environment? Are you passionate about helping others? Here at Omnicare Inc., we have a real passion for helping both our customers and our employees. We believe the role of Claims Associate will present you with such an opportunity.You will collaborate with Clinical Intervention Center (CIC) staff, pharmacy staff, nursing facility staff and physician offices to ensure timely payment of online submission of claims. You will also follow-up on all prior authorizations that have been sent to the insurer for review and communicate any necessary information to our customers.

Key Responsibilities:

*Shift is a 3 on /2 off /2 on /2 off rotation from 11A-9:30P*

Job Summary:
CIC support staff is responsible for assisting in the resolution of rejected clinical claims management (Prior Authorizations and Covered Alternative Recommendations)

Key Responsibilities:
* Work rejected real-time claims for all pharmacies supported by the CIC under the direction of the CIC pharmacists.
o Make phone calls to insurance plans.
o Work with local pharmacies to meet run times and
ensure timely dispensing of medications.
o Work with facility staff to gather pertinent information
needed to secure overrides/prior authorizations.
* Work backlog of rejects as appropriate
* Make appropriate interventions to obtain new order or Prior Authorization (PA) as directed by a CIC pharmacist
* Reconcile responses in CIC Updated queue
* Initiates Prior Authorizations as directed by a CIC pharmacist or Clinical Specialist.
* Call facility staff and prescribers to obtain pertinent information required for prior authorizations in a timely manner.
* Call insurance plans to follow-up on submitted prior authorizations in timely manner
* Communicate with CIC and local pharmacy staff regarding the outcomes of the prior authorization requests and in the case of prior authorization denials work with pertinent staff to take the appropriate next steps in the resolution of the rejection
* Communicate to the Supervisor Follow-up and then escalate to the Claims Manager any changes in prior authorization criteria or issues related with various insurance plans and processors
* Scan and send new or authorized orders to the appropriate destination
* Track all claim detail, activity, and outcome, as directed
* Review relevant CIC reports and handle accordingly
* Cross train for coverage of other positions in the CIC
* Follow all applicable government regulations including HIPAA.
* Display behavior which exemplifies employee code of conduct guidelines.
* Other duties as assigned; Job duties may vary by location.

**Registered Pharmacy Technician with South Carolina Board of Pharmacy required within 2 weeks of hire**

Our organization offers a competitive benefit package including vacation paid time off, holiday/sick time,health/dental/vision insurance,work/life balance,employee discounted stock purchase program, 401K, tuition reimbursement, and employee discounts at all CVS stores

*Shift is a 3 on /2 off /2 on /2 off rotation from 11A-9:30P*

Required Qualifications
- If not already Registered Pharmacy Technician in SC, must apply for registration with the SC Board of Pharmacy upon accepting offer.

- Healthcare experience required.

Preferred Qualifications
- State and/or Nationally Certified Pharmacy Technician preferred

High School Diploma or equivalent degree

Business Overview
It's a new day in health care.

Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation's premier health innovation company. Through our health services, insurance plans and community pharmacists, we're pioneering a bold new approach to total health. As a CVS Health colleague, you'll be at the center of it all.

We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.

CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran - we highly value and are committed to all forms of diversity in the workplace. 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. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT. We provide reasonable accommodations to qualified individuals with disabilities. If you require assistance to apply for this job, please contact our Advice and Counsel Reasonable Accommodations team. Please note that we only accept applications for employment via this site.

If technical issues are preventing you from applying to a position, contact Kenexa Helpdesk at 1-855-338-5609 or For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352.rj6_EMxgF-I-K



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