Inbound/Outbound Queue Associate

CVS Health•Work At Home-Ohio, OH

6d•$17 - $31

About The Position

Supports coordination of medical services, including intake, screening, and referrals, and promotes the quality and effectiveness of Healthcare Services. The associate handles member and provider requests, processes precertification and authorization-related transactions, and communicates with members, providers, and healthcare teams while protecting confidential information and maintaining compliant documentation. The schedule is between 8 a.m. and 6 p.m. Eastern Time, with no weekends. The work is sedentary and involves significant periods of sitting, talking, hearing, and keying, as well as visual inspection of written and computer-generated documents and a PC monitor. The position is full-time, with 40 anticipated weekly hours.

Requirements

1–2 years of experience working as a medical assistant, office assistant, or in other clinical/equivalent work.
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

Handle incoming calls and requests from members or providers about services through 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 in accordance with the benefit plan.
Conduct non-medical research, including eligibility, coordination of benefits (COB), and benefits verification.
Maintain accurate and complete documentation that meets risk-management, regulatory, and accreditation requirements.
Promote effective communication with internal and external parties, including 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 when processing transactions for members active in the program.
Support precertification administration in compliance with applicable laws, regulations, NCQA standards, company policies, and 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.