Inbound/Outbound Queue Associate

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

📋 Description

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

• Advocate for and enhance the quality effectiveness of Healthcare Services.

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

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

• Assess requests for suitable referral to medical services personnel.

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

• Conduct non-medical research, including eligibility and benefits verification, as well as Coordination of Benefits (COB).

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

• Foster communication internally and externally with claim administrators, Plan Sponsors, third-party payers, members, families, and healthcare teams.

• Safeguard member information confidentiality and comply with company policies.

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

• Assist in administering the precertification process according to relevant laws, regulations, NCQA standards, and company policies.

• Make outbound calls to providers to relay information or collect clinical details necessary for medical authorization approval.

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

• Perform sedentary tasks that involve prolonged periods of sitting, talking, hearing, and data entry.

• Employ visual acuity for detailed inspection of written and computer-generated documents and PC monitors.

⛳️ Requirements

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

• Must be a resident of Oklahoma.

• Ability to work in a 24/7 center, committing to 40 hours each week.

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

• Preferred experience of 1-2 years in a call center environment.

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

• An Associate's degree is preferred.

🏝️ Benefits

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

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being, based on eligibility.