Inbound Outbound Queue Associate – Must reside in Oklahoma

CVS Health•Work At Home-Oklahoma, OK

4d•$17 - $26

About The Position

The Inbound Outbound Queue Associate supports coordination of medical services for Aetna Better Health, including intake, screening, referrals, and administration of the precertification process. The role handles requests from members and providers through telephone, fax, and EDI; enters and researches member information in Aetna systems; and screens requests for referral to medical services staff. The associate may approve services that do not require medical review under the applicable benefit plan and performs non-medical research such as eligibility, coordination of benefits, and benefits verification. The role maintains accurate documentation that meets risk management, regulatory, and accreditation requirements; protects confidential member information; and communicates with members, providers, plan sponsors, claim administrators, third-party payers, case managers, nurses, and medical directors. It also places outbound provider calls to provide information or obtain clinical information needed for medical authorization approvals. Work is sedentary and involves extended periods of sitting, talking, hearing, and keying, along with close visual inspection of documents and a computer monitor. The associate must reside in Oklahoma and be able to work in a 24/7 center for 40 hours per week.

Requirements

Must reside in Oklahoma.
1–2 years of experience working as a medical assistant, office assistant, or in other clinical or equivalent work.
Able to work in a 24/7 center and work 40 hours each week.
High school diploma, GED, or equivalent experience.

Nice To Haves

1–2 years of call center experience.
1–2 years of prior authorization experience.
Associate degree.

Responsibilities

Coordinate medical services, including intake, screening, and referrals to Aetna Better Health.
Promote and support the quality and effectiveness of Healthcare Services.
Handle member and provider service requests received by telephone, fax, or EDI.
Use Aetna systems to build, research, and enter member information.
Screen requests and refer appropriate cases to medical services staff.
Approve services that do not require medical review in accordance with the benefit plan.
Perform non-medical research, including eligibility, coordination of benefits, and benefits verification.
Maintain accurate and complete documentation in accordance with risk management, regulatory, and accreditation requirements.
Communicate internally and externally to support the effectiveness of medical management services.
Protect confidential member information and follow company confidentiality policies.
Communicate with Aetna Case Managers when processing transactions for members active in the program.
Support precertification administration in compliance with applicable laws, regulations, NCQA standards, and company procedures.
Place outbound calls to providers to provide information or obtain clinical information for medical authorization approvals.
Communicate with Aetna Nurses and Medical Directors when processing transactions for members active in the program.