Inbound/Outbound Queue Associate

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

📋 Description

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

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

• Manage the intake of calls from members and providers regarding services through various channels such as telephone, fax, and EDI.

• Utilize Aetna systems to create, research, and input member information.

• Evaluate requests to ensure appropriate referrals to medical services personnel.

• Authorize services that do not necessitate medical review in accordance with the benefit plan.

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

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

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

• Safeguard member confidentiality and adhere to company confidentiality policies.

• Collaborate with Aetna Case Managers, Nurses, and Medical Directors during the processing of member transactions.

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

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

• Employ MedCompass, QNXT, ProFAX, and ProPAT systems.

⛳️ Requirements

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

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

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

• Sedentary work involving extended periods of sitting, talking, listening, and keying.

• Visual acuity necessary for detailed inspection of written and computer-generated documents and PC monitors.

• Associate's degree is preferred.

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

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources to support physical, emotional, and financial well-being.

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