Senior Technical Consultant
VercelSalary not specified
Full Time
Senior (5 to 8 years)
Not SpecifiedCompensation
Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, InsuranceIndustries
Requirements
Candidates must possess American Board for Certification (ABC) certification in both Prosthetics and Orthotics, with 7-10 years of clinical practice experience and at least one year of health plan/payor experience. Eligibility for a prosthetics/orthotics state license is also required, and a Bachelor's degree or equivalent is preferred.
Responsibilities
The Prosthetist DME Consultant will provide clinical expertise and business direction for medical management programs, focusing on clinical and payment policy. Responsibilities include supporting the appeal process, clinical claim reviews, pre-certification, and predetermination of benefits across commercial, Medicare, and Medicaid environments. The role involves participating in workgroups to improve healthcare quality and efficiency, applying coding and reimbursement expertise to ensure policy alignment, and using data analysis for quality improvement initiatives. This position also acts as an internal consultant on payment policy and collaborates with diverse health delivery professionals and functional areas.
Skills
Prosthetics
DME (Durable Medical Equipment)
Clinical Expertise
Medical Management
Payment Policy
Appeals
Claim Review
Reimbursement
Coding
Pre-certification
Predetermination of Benefits
Commercial Insurance
Medicare
Medicaid
CVS Health
Comprehensive pharmacy and healthcare services
About CVS Health
CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.
Woonsocket, Rhode IslandHeadquarters
1963Year Founded
DEBTCompany Stage
Healthcare, Consumer GoodsIndustries
10,001+Employees
Benefits
Health Insurance
Dental Insurance
Vision Insurance
Life Insurance
Disability Insurance
401(k) Retirement Plan
Company Equity
Wellness Program
Professional Development Budget
Paid Vacation
Paid Holidays
Risks
Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.
The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.
The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.
Differentiation
CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.
The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.
CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.
Upsides
Expansion of telehealth services allows CVS to reach more patients remotely.
Increased consumer interest in wellness boosts demand for CVS's health-related products.
The trend towards value-based care aligns with CVS's integrated healthcare approach.
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