, Connecticut

Job Description
This position will be working from home

This Medicare appeals clinical consultant position will be working with and assisting a large group of nurses and physicians with member and non contract provider Medicare appeals. The appeals consultant will support the clinical appeals area for various internal processes. Duties include but are not limited to: researching cases for pertinent components, collection of appropriate documentation, telephonically requesting clinical as needed, ability to read and/or light transcription of medical records and tasking to correct appeals que , monitor the fax bin, triage queues, assign appeals Medical Directors and Nurses, navigate through multiple computer system applications in a fast paced department and perform other duties as assigned. Must work independently as well as in a team environment while working remotely. Working closely with a clinicians, assisting with turn-around times.

Required Qualifications
Excellent verbal and written communication skills.
Working knowledge of Microsoft Office products (Word, Excel, PowerPoint,
Outlook) and Internet Explorer.
Strong organizational skills
Health Care Background
Medical Terminology

Preferred Qualifications
Coding Experience
Medicare Experience
Appeals
Utilization Review
Medical Assistant

Education
Technical school preferred.
Bachelor's degree preferred
High School Diploma or GED Required

Business Overview
At Aetna, a CVS Health company, 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 are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. 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. See Job Description

, Connecticut

Continue serving and work with a purpose

As a CVS Health colleague, you'll find career opportunities across the organization and at every stage of your career. More important, your work will have an impactful purpose on someone's life, including your own. Learn more about how you can continue serving on your next mission at CVS Health.

Careers for Veterans and Military Spouses

 

"The military has an ethos that is grounded in purpose-driven service that’s bigger than the individual. The same holds true for us at CVS Health. You can talk to colleagues in any part of our business and they will be able to articulate our company’s purpose. Working here provides an opportunity for service members and military spouses to continue to serve, just in a civvies."

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