Description
We are seeking a Medical Services Coordinator to support the comprehensive coordination of medical services, including intake, screening, and referrals to Aetna Medical Services Programs. The successful candidate will work with the Behavioral Health team and utilize various Aetna systems to build, research, and enter member information.
Responsibilities:
- Promote and support the quality effectiveness of Healthcare Services
- Perform intake of calls from members or providers regarding services via telephone, fax, EDI
- Utilize eTUMS and other Aetna systems to build, research, and enter member information
- Screen requests for appropriate referral to medical services staff
- Approve services that do not require a medical review in accordance with the benefit plan
- Perform non-medical research, including eligibility verification, COB, and benefits verification
- Maintain accurate and complete documentation of required information
- Promote communication, both internally and externally, to enhance the effectiveness of medical management services
- Protect the confidentiality of member information and adhere to company policies regarding confidentiality
- Communicate with Aetna Case Managers, Medical Directors, and Nurses when processing transactions for members active in this Program
- Support the administration of the precertification process in compliance with various laws and regulations
- Place outbound calls to providers under the direction of Medical Management Nurses to obtain clinical information for approval of medical authorizations
- Use Aetna Systems such as QNXT, ProFAX, ProPAT, and Milliman Criteria
Requirements:
- 2-4 years of experience as a medical assistant, office assistant, or other clinical experience
- Microsoft Applications, specifically Excel
- High School diploma or equivalent GED
Preferred Qualifications:
- Experience with Behavioral Health
- Healthcare experience
- Ability to multitask
Benefits:
- Comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources
Salary Range: $17.00 - $31.30 per hour