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Pharmacy Technician - Claims Associate

04/23/2019Call Center
Job Location:
Des Plaines, IL
Metro Area:
IL - Chicago
Company Name: CVS Health
2313 S. Mount Prospect Road
Des Plaines, IL
Website:  Click to Visit
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, as you will will research prior authorization (PA) requirements, gather all PA information needed, and complete the PA procedure in a timely manner. You will have the opportunity to 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. Additionally, you will be responsible for the timely and accurate distribution of phone calls and documents, as well as document storage throughout the CIC.

Shift: 9A - 5:30P, Monday - Friday plus every 5th weekend, plus one major holiday per year.

Primary Responsibilities
You will:

• Triage all incoming phone calls and faxes.
• Scan, file and electronically store all prior authorizations and other CIC related documentation.
• Work rejected real-time claims for all pharmacies supported by the CIC under the direction of the CIC pharmacists.
• Work with local pharmacies to meet run times and ensure timely dispensing of medications.
• Work with facility staff to gather pertinent information needed to secure overrides/prior authorizations.
• Initiate Prior Authorizations as directed by a CIC pharmacist or Clinical Specialist.
• Fax and electronically submit completed prior authorizations to insurance plans for review.
• Call insurance plans to follow-up on submitted prior authorizations.
• Communicate to the Supervisor staff and then escalate to the Claims Manager any changes in prior authorization criteria or issues related with various insurance plans and processors.
• Work backlog of rejects as appropriate.
• Follow all applicable government regulations including HIPAA.
• Display behavior which exemplifies employee code of conduct guidelines.

To be successful, you will possess excellent communication and organization skills, as well as the ability to work cross-functionally, multitask, meet deadlines and be flexible in a fast-paced work environment. Strong computer skills in data entry and Microsoft Office programs are also critical to your success.

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.

Required Qualifications
•Must be proficient in data entry and Microsoft Office programs.
• Pharmacy Technician Registration in IL required. If not already registered, must get registered upon accepting offer.

Preferred Qualifications
• Pharmacy experience preferred.
• Certified Pharmacy Technician preferred

•High School degree 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.

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.
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