This a Full Remote job, the offer is available from: United States, Florida (USA), Georgia (USA), Missouri (USA), North Carolina (USA), Ohio (USA), Pennsylvania (USA), South Carolina (USA), Tennessee (USA), Texas (USA)

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

Supporting comprehensive coordination of National Medical Excellence Program handling inbound calls from the phone queue.

Additional responsibilities to include but not limited to the following:

- Performs intake of calls from providers or members

- Utilizes Aetna Systems such as MedCompass, HRP, ASD, CEC, and ATV and other Aetna systems to build, research and enter member information in applicable system.

- Performs non-medical research including eligibility verification, COB, and benefits verification.

- Maintains accurate and complete documentation of required information and meets risk management, regulatory and accreditation requirements.

- Performs intake of calls from members or providers regarding services via telephone, fax, EDI.

- These duties may include but are not limited to processing referrals, making outreach calls, entering data.

- Collaborates with the clinical team, medical directors, claims and contacting staff.

- Communicates with transplant financial coordinator at the transplant center.

- Initiates authorizations regarding kidney transplants in accordance with unit processes.

- Communicates with the member or provider regarding transplant services.

- Build shell cases for transplant, cellular therapy, and gene therapy services request and task to nurse review. • Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g., Providers, family, and health care team members respectively) • 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 and/or NCQA standards, where applicable, while adhering to company policy and procedures.

- 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

- Other duties as assigned.

Required Qualifications

- 2+ years’ experience working as a medical assistant, office assistant or other clinical/equivalent experience.

- Computer skills, including Microsoft Office Suite (Specifically Excel)

- Ability to communicate with diverse populations

- Ability to collaborate with and work in a team environment

- Flexibility and ability to work independently

Preferred Qualifications

-1+ years prior Insurance experience, preferably in a Call Center.

-Telephonic Customer Service experience

-1+ years of prior authorization experience

Education

-High School Diploma or equivalent GED Required

-Associate Degree Preferred

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.