Inbound/Outbound Queue Associate

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

📋 Description

• Assist in the thorough coordination of medical services, which includes intake, screening, and referrals.

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

• Handle intake of calls from members or providers through telephone, fax, and EDI.

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

• Evaluate requests for suitable referrals from the medical services team.

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

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

• Ensure accurate and thorough documentation that meets risk management, regulatory, and accreditation standards.

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

• Safeguard member information confidentiality and adhere to company policies.

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

• Assist in the administration of the precertification process while complying with relevant laws, regulations, NCQA standards, and company policies.

• Make outbound calls to providers to relay information or gather clinical data for medical authorization approval.

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

⛳️ Requirements

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

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

• Preferred call center experience of 1-2 years.

• Prior authorization experience is preferred, with 1-2 years being ideal.

• An Associate's degree is preferred.

• Availability to work between 8 am and 6 pm EST.

• Capability to perform sedentary work that involves extended periods of sitting, talking, hearing, and data entry.

• Visual acuity to review written and computer-generated documents as well as to view a PC monitor.

🏝️ Benefits

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

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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