# Medical Coordinator

**Company**: CVS Health
**Location**: Work from home, OK
**Work arrangement**: remote
**Job type**: full-time
**Salary**: $17.00 - $25.65
**Category**: Healthcare
**Industry**: Healthcare

**Apply**: https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/OK---Work-from-home/Inbound-Outbound-Queue-Associate---Must-reside-in-Oklahoma_R1088238-1?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/job/medical-coordinator-bfc08302-a5e/

## Description

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 they do.

**Job Summary** Supports comprehensive coordination of medical services including intake, screening, and referrals to Aetna Better Health. Promotes and 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. Approves 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. Protects the confidentiality of member information and adheres to company policies regarding confidentiality. Communicates 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 and/or NCQA standards, where applicable, while adhering to company policy and procedures. Places outbound calls to providers to provide information or obtain clinical information for approval of medical authorizations. Uses Aetna Systems such as MedCompass, QNXT, ProFAX and ProPAT. 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.

**Requirements**

- 1-2 years’ experience working as a medical assistant, office assistant or other clinical/equivalent experience.

- Must reside in Oklahoma.

- Able to work in a 24/7 center and will work 40 hours each week.

**Preferred Qualifications**

- Call center experience is preferred, 1-2 years.

- Prior authorization experience, 1-2 years.

**Education**

- High School Diploma, GED or equivalent experience.

- Associates degree, preferred.

**Benefits** This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

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## Skills

### Required
- Aetna system
- MedCompass
- QNXT
- ProFAX
- ProPAT

### Nice to have
- call center experience
- prior authorization experience

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Source: [Apply at cvshealth.wd1.myworkdayjobs.com](https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/OK---Work-from-home/Inbound-Outbound-Queue-Associate---Must-reside-in-Oklahoma_R1088238-1?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)