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Inbound/Outbound Queue Associate (Prior Authorization Experience Preferred)

Primary Location: Phoenix, AZ
Additional Locations: AZ-Phoenix
This role will be to take phone calls and faxes from providers (clinics, hospitals, doctors) requesting prior authorization approval that is required for medical procedures before they can be initiated. As part of our non-clinical support team, you will be a key component in customer satisfaction and have a responsibility to make every contact informative, productive and positive for our providers. This is busy customer service environment. You’ll need to be efficient, productive and thorough dealing with our members over the phone.
  • Take inbound calls from providers in a call center environment.
  • Data entry fax request received from an inbound fax queue.
  • Assist callers from hospitals, clinics, facilities and other health care providers to create and manage requests for medical services.
  • Follow processes and guidelines to determine approved services that do not require a medical review in accordance with the benefit plan.
  • Complete special projects in accordance to business needs (i.e. return mail, member surveys, sorting) Promotes/supports quality effectiveness of Healthcare Services.

Fundamental Components:
  • Performs intake of calls from members or providers regarding services via telephone and fax 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 and COB.
  • Protects the confidentiality of member information and adheres to company policies regarding confidentiality
  • 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.

Background Experience:
  • 1 year of call center experience required.
  • 1-2 years experience as a medical assistant, office assistant or other clinical experience preferred but not required.
  • High school Diploma or G.E.D.

Additional Job Information:
  • Effective communication, telephonic and organization skills.
  • Familiarity with basic medical terminology and concepts used in care management.
  • 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.
  • Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word.
  • Ability to effectively participate in a multi-disciplinary team including internal and external participants.

Required Skills:
Service - Handling Service Challenges, Service - Working Across Boundaries

Desired Skills:
General Business - Communicating for Impact, General Business - Maximizing Work Practices, 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.

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.


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