*Representative II at NTT Data, Inc in San Antonio, Texas

Job Description:

Description

OVERVIEW

Eligibility Verification is responsible for researching and resolving mail order and retail prescriptions that will not process because there is an issue with the member's insurance coverage. Our department is the final step in a long process in order to ensure we meet our member's needs and process or reject their prescriptions accurately.

JOB DESCRIPTION

An Eligibility Verification Rep I is responsible for investigating and resolving eligibility issues on multiple platforms in order to allow requests to continue processing. This individual will communicate directly with our clients via phone, fax and/or email to ensure that eligibility information CVS/Caremark has on file for the participant is accurate. Interacts with internal and external customers. Primarily working Mail Order, Retail, Phones and Keying Projects. They will also support other duties as assigned.

DAY IN THE LIFE

The Eligibility Verification Team manages member s insurance eligibility by consulting with the Benefits Offices for verification as well as manually updating the files for those members. The department receives requests in a variety of different ways: Mail Orders (EDQ queue), Resolution Manager Tasks (retail prescriptions), and Incoming Calls (benefits offices only).

The Enrollment Rep I ensures that members are able to fill their mail order and retail store prescriptions without actually interacting with any members. This is a business to business research process.

WORK ENVIRONMENT

You will be sitting at your own cube that is not shared, for the duration of your shift, for the first three weeks of training. The fourth week of training, you will be transitioned to Work From Home. You will be required to have a workspace in your home that is private with no background noise or distractions. There are two 15 minutes breaks, one in the morning, one in the afternoon and a 45 minute lunch at midday. 100% of the work is computer based and you are provided dual monitors. On average you will receive about 10-20 incoming calls during your 8 hour shift. The majority of your work will be pulling from our error queue and reaching out to external contacts through phone calls, emails and faxes.

REQUIRED SKILLS:
- Candidates must have 2 years Customer Service Call Center experience.
- Basic Excel, Word and Outlook skills required
- 9,000 ksph at 99% accuracy
- Team player
- Attention to detail
-Ability to set up a PC and accessories in their home without assistance
-Ability to troubleshoot minor IT issues in their home, such as connectivity issues

NOTE: In addition to a broadband connection a smartphone that can download apps is required. The latter is necessary as the VPN token will need to be downloaded to the user s phone.

ADDITIONAL PREFERRED SKILLS
- Quick paced typing
- Ability to multitask
- Very detail oriented
- Ability to work independently
- Respectful of peers and superiors

REQUIRED ITEMS TO PRESENT WITH SUBMITTAL:
- Re sume
- Write up from Agency
- Data Entry Alpha and Numeric Scores
- MS Office Scores; Word, Excel, Outlook plus 10-key strokes & accuracy score.

THE FINE PRINT

This is not a call center. Candidates must be comfortable doing research; pay attention to detail; and have solid PC skills (email and Excel).

NO time off allowed during the four week training period.

This will be a send to work. The only caveat to that will be if they worked for this manager in the past, she will need to approve them to come back.

The training class is limited to 15 and due to the complexity of the training, fall-offs cannot be replaced.

The go live date is January 1st, so absolutely no requests for time off during Q1.

There is an attachment that needs to be printed and signed by the candidate and brought with them to orientation.

Candidate must report to main security office prior to the first day of class in order to obtain a security badge and to learn where to park and where to enter the building according to Covid 19 CVS Health building policies. The class will officially start on 11/2/20 at promptly 7am. No late arrivals allowed.

Verifyable High School Diploma or GED Required: Yes

Work Experience? No

Position Summary:
The Healthcare CD Representative II will work closely with providers to process prior authorization (PA), and drug benefit exception requests on behalf of Healthcare as the client and in accordance with Medicare Part D CMS Regulations. Must apply information [provided through multiple channels] to the plan criteria defined through work instruction. Research and conduct outreach via phone to requesting providers to obtain additional information to process coverage requests and complete all necessary actions to close cases. Responsible for research and correction of any issues found in the overall process. Phone assistance is required to initiate and/or resolve coverage requests. Escalate issues to Coverage Determinations and Appeals clinical pharmacists and management team as needed. Must maintain compliance at all times with CMS and department standards. Position requires schedule flexibility including rotations through nights, weekend and holiday coverage.

Duties:
Customer service focus. Basic experience in MSWord and MSExcel. Familiar with medical terminology and knowledge of medical coding. Ability to read and interpret billing documents. The position also requires an extensive amount of data entry work.

Experience:
2 years experience. 1.Strong Attention to detail 2.Excellent verbal and written communication and interpersonal skills w/ ability to maintain patient confidentiality 3.Proficient computer skills and the ability to navigate in a Windows based environment 4.Ability to follow directions, and adapt in dynamic work environment; ability to adapt to change and remain flexible 5.Ability to work in a high pressure, time sensitive environment 6.Project a professional business image, through phone interaction as well as internal communications 7.Demonstrated problem-solving ability and attention to detail 8.Demonstrated sense of urgency with assignments 9.Strong organizational skills 10.Strong telephone skills 11.Ability to read and understand pharmacy/medical terminology 12.Ability to read, analyze and interpret general business correspondence, technical procedures and governmental regulations. 13.Ability to identify and solve practical problems and deal with a variety of concrete variables in standardized situations. Ability to perform basic mathematic calculations maybe required 14.Ability to interpret a variety of work instructions provided through a variety of mediums 15.Ability to anticipate needs and resolve issues with urgency 16.Ability to consistently meet quality and production standards 17.Displays confidence in the ability to learn complex material 18.Demonstrates intellectual curiosity through inquiries to ensure deep understanding of the business and deliver accurate results

Education:
High School Diploma or GED required. Associates degree in Business, Accounting or equivalent work experience preferred.

What days & hours will the person work in this position? List training hours, if different.

NTT DATA, Inc. (the Company ) is an equal opportunity employer and makes employment decisions on the basis of merit and business needs. The Company will consider all qualified applicants for employment without regard to race, color, religious creed, citizenship, national origin, ancestry, age, sex, sexual orientation, genetic information, physical or mental disability, veteran or marital status, or any other class protected by law. To comply with applicable laws ensuring equal employment opportunities to qualified individuals with a disability, the Company will make reasonable accommodations for the known physical or mental limitations of an otherwise qualified individual with a disability who is an applicant or an employee unless undue hardship to the Company would result.

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