Inbound/Outbound Queue Associate (Prior Authorization Experience Preferred)Primary Location: Phoenix, AZ
Additional Locations: AZ-Phoenix Apply
- 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.
- 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.
- 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.
- 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.
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