Inbound/Outbound Queue Associate

Job not on LinkedIn

🔥 9 minutes ago

🌪️ Oklahoma – Remote

🌪️ Oklahoma – Remote

💵 $17 - $25 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

✨ Associate

🚫👨‍🎓 No degree required

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• 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

🎯 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