Inbound Outbound Queue Associate

This is a fully remote position, open to applicants in Oklahoma.

📋 Description

• Facilitate thorough coordination of medical services, encompassing intake, screening, and referrals to Aetna Better Health

• Advocate for and enhance the quality effectiveness of Healthcare Services

• Handle incoming calls from members or providers regarding services through telephone, fax, and EDI

• Leverage Aetna systems to create, investigate, and input member information

• Evaluate requests to ensure proper referral to medical services staff

• Authorize services that do not need medical review per the benefit plan

• Conduct non-medical research, including eligibility, COB, and benefits verification

• Ensure accurate and thorough documentation that complies with risk management, regulatory, and accreditation standards

• Encourage effective communication with claim administrators, plan sponsors, third-party payers, members, families, and healthcare team members

• Safeguard member confidentiality and adhere to company confidentiality policies

• Coordinate with Aetna Case Managers, Nurses, and Medical Directors during member transaction processing

• Assist in precertification administration in alignment with laws, regulations, NCQA standards, and company policies

• Make outbound calls to providers to share information or gather clinical details for medical authorization approval

• Utilize Aetna systems including MedCompass, QNXT, ProFAX, and ProPAT

⛳️ Requirements

• Must be a resident of Oklahoma

• 1-2 years of experience as a medical assistant, office assistant, or other clinical/equivalent roles

• Availability to work in a 24/7 center and commit to 40 hours weekly

• Preferred experience in a call center setting, 1-2 years

• Prior authorization experience is preferred, 1-2 years

• High School Diploma, GED, or equivalent experience required

• An associate's degree is preferred

• Sedentary role involving extended periods of sitting, talking, hearing, and keying

• Visual acuity necessary for reviewing written and computer-generated documents and a PC monitor

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program in addition to the base pay range

• Medical coverage

• Dental coverage

• Vision coverage

• Paid time off

• Retirement savings options

• Wellness programs

• Additional resources supporting physical, emotional, and financial well-being, subject to eligibility