National Medical Excellence Program Coordinator

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 colleagues who care deeply, innovate with purpose, hold themselves accountable and prioritize safety and quality in everything we do.

Position Summary

You'll support the comprehensive coordination of the National Medical Excellence Program, handling inbound calls from the phone queue.

Responsibilities

• Perform intake of calls from providers or members
• Utilize Aetna Systems such as MedCompass, HRP, ASD, CEC, and ATV to build, research, and enter member information
• Conduct non-medical research, including eligibility verification, COB, and benefits verification
• Maintain accurate and complete documentation of required information
• Collaborate with the clinical team, medical directors, claims, and contacting staff
• Communicate with transplant financial coordinators, members, or providers regarding transplant services
• Initiate authorizations regarding kidney transplants
• Build shell cases for transplant, cellular therapy, and gene therapy services
• Promote communication internally and externally to enhance effectiveness of medical management services
• Protect the confidentiality of member information and adhere to company policies
• Support the administration of the precertification process
• Communicate with Aetna Nurses and Medical Directors when processing transactions

Requirements

• 2+ years of experience working as a medical assistant, office assistant, or equivalent
• Computer skills, including Microsoft Office Suite (Excel)
• Ability to communicate with diverse populations and work in a team environment
• Flexibility and ability to work independently

Preferred Qualifications

• 1+ year of prior insurance experience, preferably in a call center
• Telephonic customer service experience
• 1+ year of prior authorization experience

Education

• High school diploma or equivalent GED required
• Associate degree preferred

Benefits

• Comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, and wellness programs