Job Description The Clinical Anthem Coder works directly with our Clinical Pharmacists, Clinical Requirement Advisors, as well as our internal business partners to support clinical initiatives related to the client Anthem. The duties will emphasize data analysis and set up evaluation for various programs such as Formulary and Utilization Management, especially related to CVS Health processed used for RxCLAIM Adjudication benefits designs.
This position is responsible for analyzing and evaluating changes for updating RxCLAIM related to formulary and clinical programs. Responsibilities include, but are not limited to: document review, current system validation, trending analysis, supporting ad hoc situations, coding changes into RxCLAIM system as needed for any line of business for Anthem. Interfacing with internal clients via conference calls and written communication. The Clinical Coder is responsible for ensuring accurate RxCLAIM set up through system testing and validation and following up with internal parties as needed.
Responsibilities include but not limited to:
- Analysis of existing setups to determine how request received through SFDC will fit in to current setup for any lines business
- Evaluate approach to complete client request
- Coding client requests
- Testing of client request and rework coding as needed to meet client intent
- QA of Coding and Testing completed by another team member to confirm client intent is met Required Qualifications- 1 + years of experience RxCLAIM adjudication and RxClaim query
- 1+ years of proficient experience with Microsoft Excel Preferred Qualifications- Excellent verbal and written communication skills
- Pharmacy experience
- Detail Oriented
- Time Management skills Education High School Diploma or GED required Business Overview
CVS 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
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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/