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A new day in healthcare. Together, CVS Health and Aetna help people on their path to better health.

Inbound/Outbound Queue Associate (Prior Authorization Intake/Entry)

Primary Location: Charleston, West Virginia
Additional Locations: WV-Charleston
Provide comprehensive healthcare management to facilitate delivery of appropriate quality healthcare, promote cost effective outcomes, and improve program/operational efficiency involving clinical issues through intake and screening.

Fundamental Components:

-Performs intake from calls and faxes from members or providers regarding services

-Utilizes system to enter member information, perform non-medical research such as eligibility verification, and create authorization requests as necessary

-Places outbound calls to providers under the direction of Medical Management Nurses/Supervisors to obtain clinical information regarding requests for medical authorizations

-Supports the administration of the pre-certification process in compliance with various laws and regulations, as well as NCQA standards, while adhering to company policy and procedures

-Must have the ability to multi-task and effectively manage call times to accomplish the workload efficiently

-Sedentary work involving significant periods of sitting, talking, listening, and keying. Work requires visual acuity to perform close inspection of written and computer generated documents as well as a PC monitor

Background Experience:

-2-4 years experience as a medical assistant, office assistant or other clinical experience

-Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members

-Familiarity with basic medical terminology and concepts used in utilization management

-Effective communication, telephonic, and organization skills

Required Skills:
Benefits Management - Interacting with Medical Professionals, General Business - Communicating for Impact, Service - Handling Service Challenges

Potential Telework Position:

Percent of Travel Required:
0 - 10%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Candidate Privacy Information:
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Click To Review Our Benefits (PDF)


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