Find Jobs In United States - Find the Best Jobs online
 

 

 

Check with seller Inbound Outbound Queue Associate Louisville

Published date: April 3, 2022
  • Location: Louisville, Kentucky, United States

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 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 (e.g., claim administrators, Plan Sponsors, and third-party payers as well as member, family, and 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 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, 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.
Required Qualifications
1-2 years experience working as a medical assistant, office assistant or other clinical experience.

High School Diploma or GED.

COVID Requirements

COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

Preferred Qualifications
  • Experience or detailed knowledge of the Foster Care and juvenile justice systems, Adoption Assistance, the delivery of Behavior Health Services, Trauma-informed Care, ACEs, Crisis Intervention services, and evidence-based practices applicable to the Kentucky SKY populations, is required.
  • 2-4 years’ experience as a medical assistant, office assistant or other clinical
  • experience.
  • 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.
Education
  • High School Diploma or G.E.D.
Business Overview
Bring your heart to CVS Health
Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Contact seller Share

Useful information

  • Avoid scams by acting locally or paying with PayPal
  • Never pay with Western Union, Moneygram or other anonymous payment services
  • Don't buy or sell outside of your country. Don't accept cashier cheques from outside your country
  • This site is never involved in any transaction, and does not handle payments, shipping, guarantee transactions, provide escrow services, or offer "buyer protection" or "seller certification"

Related listings

  • Customer Service Telephone Representative
    Customer Service Telephone Representative
    Protective Service - Louisville (Kentucky) - April 3, 2022 Check with seller

    Job Title: Customer Service Telephone Representative Department: Hazardous Materials Support Center – WFF West Mezzanine Days: Monday – Friday Hours: 6:30pm - 11:30pm Job Description: HMSC representatives work in an office environment located in the ...

  • Sales Associate
    Sales Associate
    Media, Communications & Writing - Louisville (Kentucky) - April 3, 2022 Check with seller

    06165 Louisville, KY LE_303 City Gear, LLCJob Title: Sales Associate Department: Operations FLSA Status: Non-Exempt Reports To: Store Manager SUMMARYThe Sales Associate is responsible for assisting the store's management staff with providing qual...

  • House Cleaning Professionals
    House Cleaning Professionals
    Cleaning & Facilities - Louisville (Kentucky) - April 3, 2022 Check with seller

    SuperCleaning Service Louisville is a local cleaning company looking for professional cleaners immediately. We operate in Louisville and surrounding cities.We're looking for high-quality independent cleaning professionals who:1. Have existing cle...

Comments

    Leave your comment (spam and offensive messages will be removed)

    Website using cooking and goole tagmanager

    Find jobs post jobs for free - wordhome - Site map xml

    chợ tốt việc làm - chợ tốt mua bán - chợ tốt bất động sản - rao vặt miễn phí - việc làm báo mua bán

    job in usa | job in singapore | job in taiwan | job in india