Compliant & Appeals Coordinator, CVS Health

CVS Health

Location:
United States, Arizona

Category:
Customer Service

Contract Type:
Employment contract

Salary:

17.00 - 28.46 USD / Hour

Save Job

Apply Position

Job Description:

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Job Responsibility:

Prepares information and reports needed to address matters regarding complaints, appeals, and grievances
Carries out policies, procedures, and programs to ensure compliance with federal and/or state regulations
Reviews, interprets, and processes appeals and grievances filed by patients, escalating more complex issues and concerns to management for review and follow-up
Performs patient and insurance report analysis and identifies any trends or issues that need to be addressed
Conducts reviews of decisions and case files to determine if there are any errors or anomalies in the application of law or evidence
Drafts and sends appeal decision letters, conducting detailed follow-up for timely and thorough follow-up and resolution
Reviews billing and coding for all current and new medical service lines for accuracy and consistency
Documents patient billing questions and concerns, subsequently inputting all detailed notes and records into the company database
Prepares educational materials, training programs, and presentations to enhance understanding of the appeals and grievances process
Coaches junior colleagues on best practices and standard operating procedures for handling complaints and appeals
Assists with the training of junior-level staff to promote the development of departmental capabilities

Requirements:

At least 1 year year of experience in Healthcare
Must reside in Arizona

Nice to have:

Medical claims experience
QNXT experience

What we offer:

Affordable medical plan options
a 401(k) plan (including matching company contributions)
an employee stock purchase plan
No-cost programs including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Benefit solutions such as paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access

Additional Information:

Job Posted:
August 22, 2025

Expiration:
September 03, 2025

Employment Type:

Fulltime

Work Type:

Remote work

View All Jobs In This Company

Job Link Share:

Compliant & Appeals Coordinator