Inbound/Outbound Queue Associate OhioRISE - Must reside in Ohio
CVS Health, Columbus, OH, United States
Position Summary
Coordinates comprehensive medical services to support the quality and effectiveness of the organization's health care services. Handles member calls regarding services and builds, researches, and enters member information into systems. Communicates with providers to obtain clinical information and enhance the effectiveness of medical management services.
Responsibilities
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 (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.
Communicates 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, while adhering to company policies 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.
Engages in sedentary work involving significant periods of sitting, talking, hearing, and keying.
Works requiring visual acuity to perform close inspection of written and computer-generated documents as well as a PC monitor.
Required Qualifications
Must reside in Ohio.
1-2 years’ experience working as a medical assistant, office assistant or other clinical or equivalent experience.
Call center experience is preferred, 1-2 years.
Preferred Qualifications
Prior authorization experience, 1-2 years.
Education
High School Diploma, GED.
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
$17.00 - $28.46
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.
Great Benefits For Great People
We offer a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. Benefits include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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Coordinates comprehensive medical services to support the quality and effectiveness of the organization's health care services. Handles member calls regarding services and builds, researches, and enters member information into systems. Communicates with providers to obtain clinical information and enhance the effectiveness of medical management services.
Responsibilities
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 (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.
Communicates 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, while adhering to company policies 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.
Engages in sedentary work involving significant periods of sitting, talking, hearing, and keying.
Works requiring visual acuity to perform close inspection of written and computer-generated documents as well as a PC monitor.
Required Qualifications
Must reside in Ohio.
1-2 years’ experience working as a medical assistant, office assistant or other clinical or equivalent experience.
Call center experience is preferred, 1-2 years.
Preferred Qualifications
Prior authorization experience, 1-2 years.
Education
High School Diploma, GED.
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
$17.00 - $28.46
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.
Great Benefits For Great People
We offer a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. Benefits include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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