Employer: CVS Health
Location:Â United States
Category:Â Customer Service | Aetna
Job Type: WFH Flexible
This is a work at home opportunity for candidates located in any time zone which includes a $1000 sign on bonus!
(Bonuses are only applicable to specific positions, locations, and business groups. Applicable roles have the bonus language in the job posting. Must be a new external candidate to the CVS/Aetna organization to be eligible.)
- Supports comprehensive coordination of medical services including intake, screening to Aetna Medical Services Programs.
- Promotes/supports quality effectiveness of Healthcare Services.
- Performs intake of calls from members or providers regarding services via telephone, fax, EDI.
- Utilizes MedCompass/ATV 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 nonmedical 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 confidentialit
- 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.
- 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.
- At least 1 year of call center experience required.
- 2 to 4 years experience as a medical assistant, office assistant or other clinical experience.
- High School Diploma or G.E.D