Claims Associate in Des Plaines, Illinois | DiversityInc Careers
 

Claims Associate

Job DescriptionOmnicare, 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: 8A - 4:30P, Monday - Friday; includes every 5th weekend from 12P – 8:30P. Plus 1 Major holiday per year.

• 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.
o Work with local pharmacies to meet run times and ensure timely dispensing of medications.
o 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•High School degree or equivalent.
•Must be proficient in data entry and Microsoft Office programs.Preferred Qualifications•6 months to one year full-time Pharmacy experience preferred.
•Certified Pharmacy Technician preferredEducation•High School degree or equivalent.Business OverviewCVS 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 and EEO IS THE LAW SUPPLEMENT

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 Advice and Counsel

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/