What We Do
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.
The CIC, Claims associate is responsible for the timely and accurate distribution of phone calls and documents, as well as document storage throughout the CIC. Claims associates will research prior authorization (PA) requirements, gather all PA information needed, and complete the PA procedure in a timely manner. Are required to work with CIC staff, pharmacy staff, nursing facility staff and physician offices to ensure timely payment of online submission of claims and responsible for follow-up on all prior authorizations that have been submitted to the insurer for review.
Shift: 10a – 6:30P, Monday – Friday; includes every 5th weekend, 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.
- Must be proficient in data entry and Microsoft Office programs.
- Strong verbal and written communication skills and the ability to work effectively cross-functionally with all levels.
- Minimum of 6 months to one year full-time Pharmacy experience.
- Certified Pharmacy Technician
- High School degree or equivalent.
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.