Inbound Outbound Queue Associate

About the position At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary Shift: Monday-Friday, 8:00am-5:00pm CST includes some weekends. Job duties include but are not limited to : 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 health care team members respectively). Protects the confidentiality of member information and adheres to company policies regarding confidentiality. Communicate with Aetna Case Managers, when processing transactions for members active in this Program Supports the administration of the peer to peer process in compliance with various laws and regulations, URAQ and/or NCQA standards, where applicable, while adhering to company policy and procedures. Schedule Peer discussions with Health Plan Medical Directors and providers. Places outbound calls to providers, - Update authorizations and complete the provider notification process. Uses Aetna Systems such as Medcompass, QNXT, ProFAX, ProPAT, 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 and accuracy. Working environment includes typical office conditions

Responsibilities

• 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 health care team members respectively).
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
• Communicate with Aetna Case Managers, when processing transactions for members active in this Program
• Supports the administration of the peer to peer process in compliance with various laws and regulations, URAQ and/or NCQA standards, where applicable, while adhering to company policy and procedures.
• Schedule Peer discussions with Health Plan Medical Directors and providers.
• Places outbound calls to providers, - Update authorizations and complete the provider notification process.
• Uses Aetna Systems such as Medcompass, QNXT, ProFAX, ProPAT
• Communicates with Aetna Nurses and Medical Directors when processing transactions for members active in this Program.

Requirements

• 1+ years of Call Center environment experience.
• Microsoft Office (Outlook, Word, Excel) skills required.
• Excellent grammar and written skills.

Nice-to-haves

• Prefers someone who resides in Louisiana
• 2-4 years' experience in a Call Center environment.
• Medical assistant, office assistant or other clinical experience preferred.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan .
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

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