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Eligibility Consultant-Electronic Ops

Company: CVS Pharmacy
Location: High Point
Posted on: March 16, 2023

Job Description:

Job Description-Under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns.-Maintains enrollment databases and coordinates electronic transfer of eligibility data.-Responds, researches, and resolves eligibility and other enrollment related issues involving member specific information; works directly with clients, vendors and/or local claim operations to achieve positive service outcomes.-Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters.-Develops tools, and provides coding supplements, file specifications and error listing to clients/vendors.-Acts as the liaison between clients, vendors with defining business requirements; identifies potential solutions and approves programming specifications required for testing. -Ensures all transactions interface accordingly with downstream systems; tests and validates data files for new or existing clients using system tools and tracks results to avoid potential problems and better address on-going service issues.-Partners with other team functions to coordinate the release of eligibility, plan structure and benefit information.-Utilizes and interprets on line resources to understand customer's account structure and benefits.-Ensures all communications with clients, third-party administrators and/or brokers involving sensitive member data adhere to HIPAA compliance requirements.Pay RangeThe typical pay range for this role is:Minimum: 17.00Maximum: 27.16Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications-Excellent customer service skills with the ability to communicate effectively with both internal and external customers. -Excellent verbal and written communication skills including articulation, spelling, grammar, proofreading and telephone skills. -Strong Excel experience -Data Entry experience -Demonstrated ability to creatively solve problems and create improvements -Ability to manage multiple tasks and shifting priorities -Ability to manage high work volume and oversee a variety of incoming work flows -A team player capable of operating independently when needed -Deliver accurate and timely results -Timely follow-up to effectively resolve an issue -Experience with EDI Files -Knowledge of 834 file layouts -High School diploma or GEDCOVID 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 Qualifications-Excellent customer service skills with the ability to communicate effectively with both internal and external customers. -Strong Excel experience -Team player-Quick learner-SFTP set up knowledge-PGP encryption-Experience with EDI Files -Knowledge of 834 file layouts -High School diploma or GEDEducation-High School diploma or GEDBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Keywords: CVS Pharmacy, High Point , Eligibility Consultant-Electronic Ops, Other , High Point, North Carolina

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