Job Description CIC support staff is responsible for assisting in the resolution of Patient Specific Therapeutic Interchange (PSTI) or 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. * Reconcile facility responses via online communication portal. * Initiates Prior Authorization and obtain pertinent information from facility/prescribers as directed by a CIC pharmacist or Clinical Specialist. * 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 any changes in prior authorization criteria or issues related with various insurance plans and processors to management team. * 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**
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
Education High School Diploma or equivalent required
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.
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