Job Description
Job Description
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 a busy customer service environment. Youll 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.
- 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
- Uses Aetna Systems such as QNXT, ProFAX, ProPAT, and Milliman Criteria.
- 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.
Required Qualifications
1 year of call center experience required.
- Effective communication, telephonic and organization skills.
- 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.
- Ability to effectively participate in a multi-disciplinary team including internal and external participants.
- Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel.
Preferred Qualifications
1-2 years' experience as a medical assistant, office assistant or other clinical experience preferred but not required.
Education
High school diploma or GED
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
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 a busy customer service environment. Youll 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.
- 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
- Uses Aetna Systems such as QNXT, ProFAX, ProPAT, and Milliman Criteria.
- 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.
Required Qualifications
1 year of call center experience required.
- Effective communication, telephonic and organization skills.
- 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.
- Ability to effectively participate in a multi-disciplinary team including internal and external participants.
- Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel.
Preferred Qualifications
1-2 years' experience as a medical assistant, office assistant or other clinical experience preferred but not required.
Education
High school diploma or GED
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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