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Position Summary
The Senior Representative, Data Reconciliation for the Medicare Prescription Payment Plan (M3P) is responsible for the review and remediation of client’s M3P opt-in/opt-out files to enable timely and accurate loading of members’ to be able to utilize the Medicare Prescription Payment Plan within the CMS mandated turn-around time.
In this position you will have the opportunity to demonstrate proficiency in the following:
- Monitor transmission and receipt of clients M3P opt-in/opt-out files.
- Create, monitor, and escalate IT tickets to resolve M3P opt-in/opt-out file issues.
- Coordinate with internal and external stakeholders for M3P opt-in/opt-out file issue resolution.
- Must be able to work a select schedule in a 24 hour, 7 day a week environment (including holidays).
- Adhere to stringent timelines consistent with CMS mandated SLA's.
- Ability to confidently speak across stakeholders with varying knowledge in either written or verbal forms including communication with customer care, eligibility, clients, and other stakeholders.
- Ability to work independently as well as in a cross functional role within other teams for collaboration on best practices.
- Proven ability to support judgment and decisions for opt-in/opt-out member adjustments using industry standard evidence and tools.
- Leads dispute resolution.
- Identifies and recommends opportunities for process improvements so that productivity and quality goals can be met or exceeded, and operational efficiency is achieved.
- Must possess high level of dependability and is able to meet accuracy and production standards.
- Monitors own work to help ensure quality.
- Required to always act in ethical manner as required under HIPAA's Privacy and Security rules to handle patient data with uncompromised adherence to the law.
- Performs other related duties as required.
Required Qualifications
- 4 years of professional experience working with and monitoring business processes including data, IT ticketing, and basic communication skills.
- Computer proficiency including experience with Microsoft Office similar products (Word, Excel, PowerPoint, Outlook, industry standard coding applications).
- Experience with submitting, tracking, and resolving IT tickets.
Preferred Qualifications
- Excellent analytical and problem-solving skills.
- Superior communication, organizational, and interpersonal skills.
- Experience with secure File Transfer Protocols (sFTP) file exchanges.
- Experience with Splunk application, including building dashboards, reports, and queries.
- RxClaim (AS400)
Education
Bachelor's Degree or equivalent work experience
Pay Range
The typical pay range for this role is:
$18.50 - $38.82This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit Benefits | CVS Health
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.