[Hiring] Inbound/Outbound Queue Associate @CVS Health

Role Description

Supports comprehensive coordination of medical services including intake, screening and referrals to Aetna Medical Services Programs. Additionally, this role will be supporting the Behavioral Health team.

Responsibilities

• Promotes/supports quality effectiveness of Healthcare Services. Performs intake of calls from members or providers regarding services via telephone, fax, EDI.
• Utilizes eTUMS and other 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 (e.g., claim administrators, Plan Sponsors, and third party payers as well as member, family, and health care team members respectively).
• 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, URAQ and/or NCQA standards, where applicable, while adhering to company policy and procedures.
• Places outbound calls to providers under the direction of Medical Management Nurses to obtain clinical information for approval of medical authorizations.
• Uses Aetna Systems such as QNXT, ProFAX, ProPAT, and Milliman Criteria.
• 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.
• Working environment includes typical office conditions.
• Will support the NJ Behavioral Health team.

Qualifications

• 2-4 years experience as a medical assistant, office assistant or other clinical experience.
• Microsoft Applications working with excel.

Preferred Qualifications

• Experience with Behavioral Health.
• Healthcare experience.
• Able to Multitask.

Education

• High School diploma or equivalent GED.

Anticipated Weekly Hours

• 40

Time Type

• Full time

Pay Range

The typical pay range for this role is: $17.00 - $31.30. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Benefits

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include:

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources, based on eligibility

Additional details about available benefits are provided during the application process and on Benefits Moments.