Patient Care Coordinator

Job Descriptionï‚ Performs follow-up on outstanding Certificates of Medical Necessity (CMNs) and processes renewal CMNs/prescriptions through the use of suspended billing reports.ï‚ Maintains and monitors follow up system to confirm that action takes place per Company's best practices.ï‚ Performs timely follow-up on renewal authorizations to maintain reimbursement activity.ï‚ Contacts patient to gain involvement in problematic situations.ï‚ Elevates aged prescriptions to manager for decision and resolution.ï‚ Evaluates all completed CMNs/prescriptions/authorizations to ensure that the appropriate information has been obtained to allow for reimbursement as well as compliance with applicable standards and regulations.ï‚ Enters CMNs/prescription information into computer once the prescriptions are completed and returned from the physicians.ï‚ Documents all account activity on system and performs internal quality audits to ensure that all necessary documentation is included in each patient file.ï‚ Processes, reviews, and mails prescription and/or CMNs to physicians for signature.ï‚ Provides feedback on errors identified to the appropriate supervisor through the use of the ENF process or other accepted method.ï‚ Researches diagnosis and insurance benefits to receive proper reimbursement.ï‚ Assists in obtaining authorization for reimbursement for some accounts.ï‚ Requests adjustments on accounts and recommends necessary changes to supervisor.ï‚ Complies with and adheres to all regulatory compliance areas, policies and procedures, and best practices.ï‚ Performs other duties and responsibilities as assigned.Required Qualificationsï‚ High school diploma or equivalent.ï‚ Minimum one year of related experience.ï‚ Strong service orientation and customer service attitude.ï‚ Effective verbal and written communication skills.ï‚ Basic computer skills.COVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred QualificationsHome Infusion experienceWorking knowledge of medical terminologyStrong mathematical skillsPrior Healthcare experienceEducationHigh School Diploma/GEDBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2025-10-04