Inbound/Outbound Queue Associate

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

📋 Description

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

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

• Manage service requests from members and providers through telephone, fax, and EDI.

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

• Evaluate requests for referral to medical services personnel.

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

• Perform eligibility, COB, and benefits verification analysis.

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

• Facilitate communication internally and externally with claim administrators, plan sponsors, third-party payers, members, families, and healthcare team members.

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

• Assist with the precertification process in accordance with laws, regulations, NCQA standards, and company policies.

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

⛳️ Requirements

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

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

• Preferred call center experience of 1-2 years.

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

• An Associate degree is preferred.

• Capability to perform sedentary tasks that involve extended periods of sitting, talking, hearing, and keyboarding.

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

• Proficient in using Aetna systems such as MedCompass, QNXT, ProFAX, and ProPAT.

• Commitment to safeguarding confidential member information and adhering to company confidentiality policies.

🏝️ 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 along with base pay.