Inbound/Outbound Queue Associate

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

The Inbound/Outbound Queue Associate is a fully telework position. The schedule is Wednesday through Sunday, 8am-5pm CST.

• Supports comprehensive coordination of medical services including intake, screening and referrals to Aetna Medical Services Programs.
• Promotes/supports quality effectiveness of Healthcare Services.
• Performs intake of calls from members or providers regarding services via telephone, fax, EDI.
• Utilizes eMEVS and other Aetna systems 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.
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
• Supports the administration of the precertification process in compliance with various laws and regulations, URAQ and/or NCQA standards, where applicable, while adhering to company policy and procedures.
• 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, FAXHUB, ProPAT, and MedCompass.
• Communicates with Aetna Nurses and Medical Directors, when processing

• High School Diploma or G.E.D

• 2-4 years of medical assistant experience

• High School Diploma or G.E.D

• 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.