CVS Health logo
CVS Health

Bringing our heart to every moment of your health.

Quality Specialist

Product SpecialistProduct SpecialistFull TimeRemoteMid LevelTeam 10,001+Since 1963H1B No SponsorCompany SiteLinkedIn

Location

CST (UTC-6)

Posted

5 days ago

Salary

$19 - $42 / hour

Seniority

Mid Level

No structured requirement data.

Job Description

Quality Specialist

CVS Health

Role Description Quality Specialist- Medicare D Quality role administers the quality management system to manage the review of clinical processes, documentation, and patient records. Interprets regulatory requirements from agencies and governing bodies to assist in the development of compliance policies and procedures. - Rework team hours of operation are Monday through Friday from 6:00 AM - 7:30 PM Central Standard Time (CST) - Schedule flexibility including nights, weekend, and holiday coverage. - This is a full time work from home position. Additional Responsibilities include but are not limited to the following: - Learning the rework queues for each line of business - Working rework reports timely - Researching and troubleshooting failed claims - Adding and/or editing overrides in RxClaim - Logging audits and errors accurately and timely - Ability to identify trends and provide suggestions for process improvement - Researching and correcting any issues found in the overall process - Raising issues to Coverage Determination Clinical Pharmacists and Management team as needed - Reading, analyzing, and interpreting general business correspondence, technical procedures, and governmental regulations - Solving practical problems and dealing with multiple concrete variables in standardized situations - Performing basic mathematical calculations - Ensuring all cases are properly closed - Ability to interpret a variety of work instructions provided through multiple mediums - Ability to anticipate needs and resolve issues with urgency and to meet quality and production standards Qualifications - 2 years of Coverage Determination & Appeals experience - MHK, RxClaim, and People Safe proficient - Meeting quality and productivity metrics in current role Requirements - 3 years of Coverage Determination & Appeals experience (Preferred) - 1 year of Medicare PART B experience (Preferred) - MHK, RxClaim, and People Safe proficient (Preferred) - Meeting quality and productivity metrics in current role (Preferred) Education - High School Diploma or equivalent GED Benefits - Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families - Medical, dental, and vision coverage - Paid time off - Retirement savings options - Wellness programs and other resources, based on eligibility Pay Range The typical pay range for this role is: $18.50 - $42.35. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography, and other relevant factors. This position is eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range listed above.

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