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We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. CVS Health/Specialty is offering an exciting opportunity to be part of our Pharmacy Care Representative team. In this customer service role, you will interact directly with customers to answer questions, solve problems, provide education, and maintain our company’s reputation for high-quality service. This includes new patient enrollment, verification of insurance coverage, performing benefit investigations and processing of medication orders for both new and existing patients. Qualified candidates will be comfortable in a multi-tasking, high-energy environment. Creative problem solvers with a passion for excellent customer service.
Job Responsibility:
Conduct inbound or outbound phone calls to patients regarding complex Specialty medication orders, benefits verification, and new patient enrollment
Coordinate and process requests for new and refill order shipments
Collect appropriate information needed to ensure insurance coverage for patient medication orders
Verify eligibility, prior authorization, and other reimbursement requirements prior to shipment
Assist in enrolling and tracking new customer referrals
Provide explanation of CVS/Specialty services to new customers
Transfer/escalate clinical questions and issues to the staff pharmacist for resolution
Requirements:
Must live within 75 miles of Las Vegas, NV
1+ years of experience in a customer service role handling and resolving a high volume of complex customer needs over the phone
1+ years of work experience with Windows-based applications like Microsoft Office (Outlook, Excel, Teams, Word) internet navigation, and email applications
1+ years of computer keyboarding experience, skills and aptitude
You must have a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload
A secure and private home workspace free from distractions is required
High School Diploma or equivalent work experience
Nice to have:
Prior healthcare work experience and familiarity with benefits, insurance, prescriptions, medical terminology
Previous experience working with Prior Authorizations
Experience with various insurance plans offered by both government and commercial insurances (i.e., PPO, HMO, EPO, POS, Medicare, Medicaid, HRA’s) and coordination of healthcare benefits, including requirements for referral, authorization, and pre-determination
Experience with reading, and understanding medical policy information, and utilizing insurance benefit and coverage information to calculate estimated patient responsibility, taking into consideration pre-determination, referral, authorization, and contract terms
Experience receiving inbound calls and making outbound calls to patients to explain insurance benefits related to health insurance, and/or discussing patient financial responsibilities
Knowledge with using Avaya-One X, Availity, Change HealthCare and/or CoverMyMeds
Pharmacy Technician license
What we offer:
Medical, dental, vision insurance
Wide-ranging list of supplemental benefits and discount programs
Sixteen paid days off
Ten paid holidays
Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching