Utah, Arizona, Virginia, Connecticut, Florida, Missouri, Maryland
Job DescriptionThis position supports management by providing Complaints Tracking Module (CTM) adjudication and beneficiary protection as prescribed by CMS.
Employee must sit in a Magellan office.
- Reviews and investigates complaints filed directly with CMS via the CMS Compliant Tracking Module (CTM) while remaining compliant with CMS timelines and guidance at all times.
- Conducts investigations, provides root cause analysis, and recommends appropriate resolutions.
- Outreach to beneficiary required.
- Maintains case files and updates CTM log accordingly.
General Job Information
Job FamilyLegal Group
CountryUnited States of America
FLSA StatusUnited States of America (Non-Exempt)
Recruiting Start Date2/6/2019
Date Requisition Created1/31/2019
EducationA Combination of Education and Work Experience May Be Considered. (Required), Bachelors (Required)
License and Certifications - RequiredCPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy
License and Certifications - Preferred
Other Job Requirements
- This position requires rotational weekend work.
- Requires attention to detail and identification of trends and risk area.
- Familiarity with all lines of Pharmacy Benefit Management (PBM) and Prescription Drug Plan (PDP) business.
- Previous escalation resolution experience.
- Excellent verbal and written communication and analytical skills.
- Previous experience in data entry, customer service and claims.
- Ability to identify, trend and communicate risk effectively.
- Outstanding customer service skills.
- Experience in Medicare compliance field or related area.
- Familiarity with standard concepts, practices and procedures within Healthcare industry.
- Familiarity with Federal and State regulations for Medicare.
- Working knowledge of Microsoft Office Product Suite.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled
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Meaningful Work With People Who Care
At Magellan Health you can do meaningful work and feel confident that you matter in an organization that makes a real difference in the world - one that cares deeply and uses its employees’ collective insight as a competitive advantage.Read More
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