Inbound/Outbound Queue Associate

Job not on LinkedIn

🔥 0 minutes ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

💵 $17 - $31 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

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

• Support comprehensive coordination of medical services, including intake, screening and referrals to Aetna Medical Services Programs • Support the Behavioral Health team and NJ Behavioral Health team • Perform intake of member or provider calls regarding services via telephone, fax and EDI • Use eTUMS and other Aetna systems to build, research and enter member information • Screen requests for appropriate referral to medical services staff • Approve services not requiring medical review in accordance with benefit plans • Perform eligibility, coordination of benefits and benefits verification research • Maintain accurate documentation meeting risk management, regulatory and accreditation requirements • Communicate with claim administrators, plan sponsors, third-party payers, members, families and healthcare team members • Protect member information confidentiality and follow company policies • Communicate with Aetna Case Managers, Nurses and Medical Directors when processing member transactions • Support precertification processes in compliance with applicable laws, regulations, URAQ and/or NCQA standards • Place outbound provider calls under Medical Management Nurse direction to obtain clinical information for medical authorizations • Use Aetna systems including QNXT, ProFAX, ProPAT and Milliman Criteria

🎯 Requirements

• 2-4 years of experience as a medical assistant, office assistant or other clinical experience • Working knowledge of Microsoft applications, including Excel • High School diploma or equivalent GED • Experience with Behavioral Health preferred • Healthcare experience preferred • Ability to multitask preferred • Ability to work Monday-Friday, 8:00AM-5:00PM EST

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program eligibility