Inbound/Outbound Queue Associate
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Job Description
Inbound/Outbound Queue Associate coordinating member and provider medical-service requests for CVS Health’s Aetna Better Health. Managing intake, eligibility verification, referrals, and precertification support remotely.
Responsibilities:
- Support comprehensive coordination of medical services, including intake, screening, and referrals to Aetna Better Health
- Promote and support quality effectiveness of Healthcare Services
- Perform intake of member and provider calls regarding services via telephone, fax, and EDI
- Use Aetna systems to build, research, and enter member information
- Screen requests for appropriate referral to medical services staff
- Approve services that do not require medical review according to the benefit plan
- Perform non-medical research, including eligibility, COB, and benefits verification
- Maintain accurate documentation meeting risk management, regulatory, and accreditation requirements
- Promote internal and external communication with claim administrators, Plan Sponsors, third-party payers, members, families, and healthcare team members
- Protect member confidentiality and follow company confidentiality policies
- Communicate with Aetna Case Managers, Nurses, and Medical Directors when processing member transactions
- Support precertification administration in compliance with laws, regulations, NCQA standards, and company procedures
- Place outbound calls to providers to provide information or obtain clinical information for medical authorization approval
- Use MedCompass, QNXT, ProFAX, and ProPAT systems
Requirements:
- 1-2 years experience working as a medical assistant, office assistant or other clinical/equivalent experience
- 1-2 years call center experience
- High School Diploma, GED or equivalent experience
- Sedentary work involving significant periods of sitting, talking, hearing, and keying
- Visual acuity to perform close inspection of written and computer-generated documents and a PC monitor
- Associates degree, preferred
- Prior authorization experience, 1-2 years, preferred
Benefits:
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
- CVS Health bonus, commission or short-term incentive program in addition to base pay
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