Inbound/Outbound Queue Associate

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

📋 Description

• Assist in the comprehensive coordination of medical services, which includes intake, screening, and referrals to Aetna Medical Services Programs.

• Provide support to both the Behavioral Health team and the NJ Behavioral Health team.

• Handle the intake process for member or provider inquiries regarding services through telephone, fax, and EDI.

• Utilize eTUMS and other Aetna systems to create, research, and enter member information.

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

• Authorize services that do not require medical review in line with benefit plans.

• Conduct eligibility checks, coordinate benefits, and perform benefits verification research.

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

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

• Safeguard the confidentiality of member information and adhere to company policies.

• Collaborate with Aetna Case Managers, Nurses, and Medical Directors when processing member transactions.

• Assist in the precertification processes in accordance with relevant laws, regulations, URAQ, and/or NCQA standards.

• Make outbound provider calls under the direction of the Medical Management Nurse to collect clinical information for medical authorizations.

• Leverage Aetna systems such as QNXT, ProFAX, ProPAT, and Milliman Criteria.

⛳️ Requirements

• 2-4 years of experience as a medical assistant, office assistant, or in another clinical role.

• Proficient in Microsoft applications, including Excel.

• High School diploma or equivalent GED required.

• Experience in Behavioral Health is preferred.

• Prior healthcare experience is advantageous.

• Ability to multitask is preferred.

• Availability to work Monday through Friday from 8:00 AM to 5:00 PM EST.

🏝️ 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.

• Eligibility for CVS Health bonus, commission, or short-term incentive programs.