Inbound/Outbound Queue Associate

$35,360 - $53,352/Yr

CVS Health - Charleston, WV

Full-time - Entry Level

Charleston, WV

Health and Personal Care Retailers

About the position

The Inbound/Outbound Queue Associate at CVS Health plays a crucial role in coordinating medical services, including intake, screening, and referrals to Aetna Better Health. This position emphasizes quality effectiveness in healthcare services and involves communication with members, providers, and internal teams to ensure efficient medical management. The associate will handle calls, perform eligibility verification, and maintain documentation while adhering to confidentiality and regulatory standards.

Responsibilities

• Promotes/supports quality effectiveness of Healthcare Services.
• Performs intake of calls from members or providers regarding services via telephone, fax, EDI.
• Utilizes Aetna system to build, research and enter member information.
• Screens 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, COB, and benefits verification.
• 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.
• 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 precertification process in compliance with various laws and regulations and/or NCQA standards.
• Places outbound calls to providers to provide information or obtain clinical information for approval of medical authorizations.
• Uses Aetna Systems such as MedCompass, QNXT, ProFAX and ProPAT.
• Communicates with Aetna Nurses and Medical Directors when processing transactions for members active in this Program.

Requirements

• 1 year experience working as a medical assistant, office assistant or other clinical/equivalent experience.

Nice-to-haves

• Call center experience is preferred, 1 year
• Prior authorization experience, 1 year
• Associates degree

Benefits

• Full range of medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Employee Stock Purchase Plan.
• Fully-paid term life insurance plan.
• Short-term and long-term disability benefits.
• Well-being programs.
• Education assistance and free development courses.
• CVS store discount and discount programs with participating partners.
• Paid Time Off (PTO) or vacation pay.
• Paid holidays throughout the calendar year.