CVS Health Sr ConsultantMember Comm in Scottsdale, Arizona

Job Description

The Medicare Part D Explanation of Benefits (EOB) department is responsible for producing a monthly Beneficiary mailing containing the summary of claim activity. The Member Communication Sr. Consultant is responsible for providing the Med D EOB department operational and testing support with strict adherence to departmental processes, testing guidelines, Centers for Medicare and Medicaid Services (CMS) guidelines and recommendations, under the guidance of the EOB Production Manager.

As a Member Communication Sr. Consultant you will:

•Provide and develop operational oversight of quality and testing standards, review and perform test on all programs prior to implementation to verify consistency and conformance to departmental guidelines

•Conduct a quality assurance review on CMS Explanation of Benefits (EOB) documentation to ensure the monthly EOB mailing continues to meet CMS guidelines and Client expectations

•Review cycles of proof samples that are generated by the Print Vendor and ensures quality and accuracy

•Research errors and work to either correct discrepancies internally or provide necessary mapping/coding updates to the print vendor

•Provide mapped document templates to Print Vendors for EOB production

•Work with internal partners on the development of data files

•Review Data files provided by IT for accuracy

•Research claim and balancing issues

•Provide support for Medicare Part D EOB audits, service level agreements and performance guarantees.

•Provide technical advice and support on data analysis and correction, training and problem solving

•Collect and compile statistical quality/operational data and prepare reports to communicate outcomes of quality assurance and operational activities, to be completed timely and accurately in order to meet/exceed internal customer and client expectations; in support of client performance guarantees, service level agreements and submission deadlines

Required Qualifications

  • 3+ years of relevant quality assurance and analytical skills

  • 2+ years of proven experience with MS Excel, Access and Word, Adobe Suite, and Visio

Preferred Qualifications

Experience in the PBM Industry and/or Medicare Part D Services

Education

Verifiable High School diploma or GED is required.

Bachelors preferred

Business Overview

CVS Health, 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.

CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW at https://www.dol.gov/ofccp/regs/compliance/posters/pdf/eeopost.pdf and EEO IS THE LAW SUPPLEMENT at https://www.dol.gov/ofccp/regs/compliance/posters/ofccpost.htm

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking EEO AA CVS Health at mailto:EEO_AA@CVSHealth.com

CVS Health does not require nor expect that applicants disclose their compensation history during the application, interview, and hiring process.

For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-338-5609. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. Please note that we only accept resumes via our corporate website: https://jobs.cvshealth.com/