Inbound Outbound Queue Associate

Supports comprehensive coordination of medical services
including intake, screening and referrals to Aetna Medical
Services Programs.
Promotes/supports quality effectiveness of Healthcare
Services.
Performs intake of calls from members or providers
regarding services via telephone, fax, EDI.
Utilizes eTUMS and other Aetna system to build, research
and enter member information.
Screens requests for appropriate referral to
medical services staff.
Approve services that do not require a medical review in
accordance with the benefit plan.
Performs non-medical research including eligibility
verification, COB, and benefits verification.
Maintains accurate and complete documentation of
required information that meets risk management,
regulatory, and accreditation requirements.
Promotes communication, both internally and externally to
enhance effectiveness of medical management services
(e.g., claim administrators,
Plan Sponsors, and third party payers as well as member,
family, and health care team members respectively).
Protects the confidentiality of member information and
adheres to company policies regarding confidentiality
Communicate with Aetna Case Managers, when
processing transactions for members active in this
Program
Supports the administration of the precertification process
in compliance with various laws and regulations, URAQ
and/or NCQA standards, where applicable, while adhering
to company policy and procedures.
Places outbound calls to providers under the direction of
Medical Management Nurses to obtain clinical information
for approval of medical authorizations.
Uses Aetna Systems such as QNXT, ProFAX, ProPAT, and
Milliman Criteria.
Communicates with Aetna Nurses and Medical Directors,
when processing transactions for members active in this
Program.
Sedentary work involving significant periods of sitting, talking, hearing and keying.
Work requires visual acuity to perform close inspection of
written and computer generated documents as well as a
PC monitor.
Working environment includes typical office conditions.
Pay Range
The typical pay range for this role is:
Minimum: 17.00
Maximum: 27.90
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
2-4 years experience as a medical assistant, office
assistant or other clinical experience.
High School Diploma or G.E.D
Preferred Qualifications
Please review required qualifications above
Education
High School diploma/GED or equivalent experience
Business Overview
Bring your heart to CVS Health Every 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. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.