InboundOutbound Queue Associate

Were building a world of health around every individual shaping a more connected convenient and compassionate health experience. At CVS Health youll be surrounded by passionate colleagues who care deeply innovate with purpose hold ourselvesaccountable 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.

Position Summary:

Work schedule: between 8am-6pmEST no weekends.
- Supports comprehensive coordination of medical services including intake screening and referrals to Aetna Better Health.

- 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 from 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 involves 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.
Required Qualifications
1-2 years experience working as a medical assistant office assistant or other clinical/equivalent experience.
Preferred Qualifications
- Call center experience is preferred 1-2 years

- Prior authorization experience 1-2 years
Education
- Associates degree preferred

- High School Diploma GED or equivalent experience.

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience education geography and other relevant factors. This position is eligible for a CVS Health bonus commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers patients members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws.