Inbound/Outbound Queue Associate

About the position

The Inbound/Outbound Queue Associate at CVS Health is a permanent work-from-home position focused on coordinating medical services and supporting healthcare effectiveness. The role involves handling calls from members and providers, utilizing various systems to manage member information, and ensuring compliance with medical service protocols. The position emphasizes communication and documentation to enhance medical management services while maintaining confidentiality and adhering to company policies.

Responsibilities
? Supports comprehensive coordination of medical services including intake and screening to Aetna Medical Services Programs.
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? Promotes/supports quality effectiveness of Healthcare Services.
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? Performs intake of calls from members or providers regarding services via telephone, fax, EDI.
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? Utilizes MedCompass/ATV and other Aetna systems to build, research, and enter member information.
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? Screens requests for appropriate referral to medical services staff.
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? Approves services that do not require a medical review in accordance with the benefit plan.
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? Performs non-medical research including eligibility verification, COB, and benefits verification.
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? Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
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? Promotes communication internally and externally to enhance effectiveness of medical management services.
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? Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
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? Communicates with Aetna Case Managers when processing transactions for members active in this Program.
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? Supports the administration of the precertification process in compliance with various laws and regulations.

Requirements
? 1 plus years of call center experience required.
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? High School Diploma or GED.

Nice-to-haves
? 2 plus years experience as a medical assistant or office assistant.

Benefits
? Full range of medical, dental, and vision benefits.
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? 401(k) retirement savings plan.
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? Employee Stock Purchase Plan.
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? Fully-paid term life insurance plan.
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? Short-term and long-term disability benefits.
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? Well-being programs.
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? Education assistance and free development courses.
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? CVS store discount and discount programs with participating partners.
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? Paid Time Off (PTO) or vacation pay.
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? Paid holidays throughout the calendar year.

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