Inbound/Outbound Queue Associate

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

📋 Description

• Oversee medical services coordination, encompassing intake, screening, and referrals.

• Advocate for and enhance the quality and effectiveness of healthcare services.

• Handle member and provider inquiries regarding services through telephone, fax, and EDI.

• Gather, research, and input member data into Aetna systems.

• Evaluate requests for referrals to medical services personnel.

• Authorize services that do not require medical review in alignment with the benefit plan.

• Carry out eligibility, COB, and benefits verification procedures.

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

• Collaborate with claim administrators, plan sponsors, third-party payers, members, families, and healthcare team members.

• Safeguard member information confidentiality and adhere to company policies.

• Interact with Aetna Case Managers, Nurses, and Medical Directors.

• Facilitate precertification processes in accordance with laws, regulations, NCQA standards, and company protocols.

• Make outbound calls to providers to share information or gather clinical data for medical authorization approvals.

• Utilize Aetna systems such as MedCompass, QNXT, ProFAX, and ProPAT.

• Engage in sedentary tasks that require prolonged periods of sitting, talking, hearing, and typing.

⛳️ Requirements

• 1-2 years of experience as a medical assistant, office assistant, or in a similar clinical role.

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

• Prior authorization background preferred, with 1-2 years of experience.

• High School Diploma, GED, or relevant equivalent experience.

• Direct or hardwired internet connection to a modem/router within 7 feet of the workstation.

• Minimum internet speed of 25 Mbps download and 3 Mbps upload.

• A quiet, secure, and private home workspace that complies with CVS Health and HIPAA regulations.

• Must reside and work within the state and city of current residence.

• Proficient in setting up and using multiple monitors and navigating various applications.

• Familiarity with email, calendar invites, Teams messaging, and virtual meetings.

• Experience with Microsoft Office 365 or comparable Google Workspace applications.

• Capability to log into secure systems such as VPN and EHR portals.

• Competence in managing strong passwords and identifying suspicious emails or links.

• Ability to independently troubleshoot common technical issues.

• Willingness to learn new skills.

• Must supply own workspace furniture.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program alongside base salary.

• Health insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources promoting physical, emotional, and financial wellness.

• Company-provided equipment including keyboard, monitor, computer, headset, etc.