Inbound Outbound Queue Associate

CVS Health•Work At Home-Louisiana, LA

2d•$17 - $26•Remote

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Requirements

1-2 years’ experience working as a medical assistant, office assistant or other clinical/equivalent experience
You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted.
A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.
Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.
Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
Future Growth: Openness to learning new skills in the future as the workplace environment evolves

Nice To Haves

Call center experience is preferred, 1-2 years
Prior authorization experience, 1-2 years

Responsibilities

Supports comprehensive coordination of medical services including intake, screening, and referrals.
Promotes/supports quality effectiveness of Healthcare Services.
Performs intake of calls from members or providers regarding services via telephone, fax, EDI.
Utilizes 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 and/or NCQA standards, where applicable, while adhering to company policy and procedures.
Places outbound calls to providers to provide information or obtain clinical information for approval of medical authorizations.
Uses Aetna Systems such as MedCompass, QNXT, ProFAX and ProPAT.
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.