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CVS Health

CVS Health is a leading healthcare company operating CVS Specialty, CVS Pharmacy, CVS MinuteClinic, and CVS Caremark. In 2018, CVS combined forces with healthca

Inbound/Outbound Queue Associate

Location

Oklahoma

Posted

2 days ago

Salary

$17 - $25 / hour

Seniority

Mid Level

High School1 yr expEnglish

Job Description

Inbound/Outbound Queue Associate

CVS Health

• Supports comprehensive coordination of medical services including intake, screening, and referrals to Aetna Better Health • Promotes/supports quality effectiveness of Healthcare Services • Performs intake of calls from members or providers regarding services via telephone, fax, EDI • Utilizes Aetna system to build, research and enter member information • Screens requests for appropriate referral to medical services staff • Approve services that do not require a medical review in accordance with the benefit plan • Performs non-medical research including eligibility verification, COB, and benefits verification • Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements • Promotes communication, both internally and externally to enhance effectiveness of medical management services • Protects the confidentiality of member information and adheres to company policies regarding confidentiality • Communicate with Aetna Case Managers, when processing transactions for members active in this Program • Supports the administration of the precertification process in compliance with various laws and regulations and/or NCQA standards, where applicable, while adhering to company policy and procedures • Places outbound calls to providers to provide information or obtain clinical information for approval of medical authorizations • Uses Aetna Systems such as MedCompass, QNXT, ProFAX and ProPAT • Communicates with Aetna Nurses and Medical Directors when processing transactions for members active in this Program • Sedentary work involving significant periods of sitting, talking, hearing, and keying • Work requires visual acuity to perform close inspection of written and computer-generated documents as well as a PC monitor

Job Requirements

  • 1-2 years’ experience working as a medical assistant, office assistant or other clinical/equivalent experience
  • Must reside in Oklahoma
  • Able to work in a 24/7 center and will work 40 hours each week
  • Call center experience is preferred, 1-2 years prior authorization experience, 1-2 years

Benefits

  • medical, dental, and vision coverage
  • paid time off
  • retirement savings options
  • wellness programs

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