Cost Management Assistant
CVS Pharmacy - New York City, NY
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Job DescriptionWill manage the flow of required information between various carriers and Meritain Health as client, for supporting high dollar claim review as it relates to cost-containment. The candidate will require the necessary level of skill to work off of a claim platform and be able to interact with all necessary departments to gather and provide the required claim information necessary at a high level of detail, accuracy, and timeliness. The candidate will be responsible for supporting, attending, or doing investigation, regarding all necessary calls and meetings with internal and external parties, document these calls as needed, file all communications, and provide support for historical queries in the event of disputes and challenges that may arise.Required QualificationsProficiency with Microsoft Outlook products, to include, Word, Excel, Outlook, with edit and formatting skillsMust have a good understanding of the Medical Claims and the Self-Funded industry Should have a basic understanding of reinsurance stop loss procedures.Must have a sound understanding of HIPAA privacy and security guidelines as it relates to Protected Health Information and the dissemination of such information to outside partiesMust have strong organizational and interpersonal communication skills and be able to plan, schedule, and facilitate a variety of discussions with planned action items for follow-up and completion independentlyStrong analytical skills, with the ability to work under pressure, meet timelines as requested, and deliver organized summary presentations as needed, both orally and in writingMust be willing to learn on an ongoing Policy, Industry Standards, Software, research methods, and interpretation of policy as it relates to this role and the industryMust be adaptable to a dynamic work environment and take on added responsibilities as needed as it meets the team's needs to support an efficient multi-faceted approach to cost-containment for Meritain HealthMust communicate and manage expectations while supporting a broad range of team supportMust be able to manage, track, and assign duties through a "community" email distribution and email boxes for a variety of business needsCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred QualificationsStrong Medical Claims background (HCPCS, ASC, DRG, Revenue codes, ICD-9/10) Working knowledge of, and navigation of, Data General (Meritain Data Management Platform) or other claim platform with proficiencyProject work, or Business Analysis backgrounds with recognized teamwork skills and demonstrated successDevelopment of and creation of workflows and necessary related Policy and ProceduresEducationHigh School Degree or equivalent, and would prefer to have a additionally 2+ years of work in the "insurance" industry, or business support/administrative backgroundBusiness OverviewAt Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. 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.
Created: 2024-09-07