Job Description

:

POSITION SUMMARY:

The Business Configuration Sr. Coordinator is responsible for the operational development and performance of prior authorization criteria to include configuration data, clinical protocols, and medical notification documents within CVS Health\xe2\x80\x99s Medical Claims and Prior Authorization platform (Novologix). The position works closely with other business teams to manage scheduled and ad hoc projects for new implementation and maintenance of existing clients. There are cross-functional responsibilities to support other departments within CVS Health as required.

PRIMARY DUTIES AND RESPONSIBILITIES: List the top four or five primary responsibilities of the position in the space provided below, indicating the approximate percentage of time spent on each.

Responsibilities

% Time*

• Analyze, build, update and test clinical criteria, system configuration, and medical notification documents to the specifications of individual client requirements. Identify and communicate details of system issues to proper team resource and track to resolution.

70%

• Communicate with and support internal and external clients through development, implementation, and maintenance of Novologix system enhancements and projects.

10%

• Participate in the implementation of new products and system enhancements by providing data and recommendations to assist in evaluating the impact of the proposed benefit, system, or process changes.

10%

• Investigate and troubleshoot Novologix system incidents and assist clients in their resolution as related to prior authorization criteria and configuration set up.

5%

• Assist other business support departments with claims review, fee schedule builds, and client maintenance as needed.

5%

EDUCATION: Indicate the level of education TYPICALLY required for the position and area of concentration. Enter \xe2\x80\x9cR\xe2\x80\x9d for Required or \xe2\x80\x9cP\xe2\x80\x9d for Preferred.

PRIOR WORK EXPERIENCE: Indicate the amount of prior RELATED work experience TYPICALLY required to fulfill the responsibilities of the position. Enter \xe2\x80\x9cR\xe2\x80\x9d for Required or \xe2\x80\x9cP\xe2\x80\x9d for Preferred.

REQUIRED SKILLS & OTHER MINIMUM REQUIRED QUALIFICATIONS: List specific skills or talents that a qualified incumbent should possess (i.e., management of large staff, computer applications, subject knowledge, etc.)

• BA/BS in mathematics, statistics, health care management, business, economics, finance or related field OR equivalent years of experience required
• 3+ years of MS Office experience
• Strong verbal and written communication skills
• 3+ years demonstrated ability to work independently and manage multiple projects and prioritize and delegate deliverables in a timely fashion
• 3+ years working within an IT or Healthcare environment preferred
• Change agile; willing and able to adjust individual and team direction based upon changing priorities and business need
• Ability to think critically, problem solve and make decisions while anticipating the broad impact of decisions
• Familiar with state and federal pharmaceutical regulations preferred

EXL Service