Description
We're building a world of health around every individual , shaping a more connected, convenient, and compassionate health experience.
Position Summary: Work schedule: between 8am-6pm EST, no weekends. Supports comprehensive coordination of medical services including intake, screening, and referrals to Aetna Better Health.
Key Responsibilities:
- Perform intake of calls from members or providers regarding services via telephone, fax, EDI.
- Utilize Aetna system to build, research, and enter member information.
- Screen requests for appropriate referral from 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 that meets risk management, regulatory, and accreditation requirements.
- Promote communication, both internally and externally, to enhance effectiveness of medical management services.
- Protect the confidentiality of member information and adhere to company policies regarding confidentiality.
- Communicate with Aetna Case Managers, Nurses, and Medical Directors when processing transactions for members active in this Program.
- Support the administration of the precertification process in compliance with various laws and regulations and/or NCQA standards.
- Place outbound calls to providers to provide information or obtain clinical information for approval of medical authorizations.
- Use Aetna Systems such as MedCompass, QNXT, ProFAX, and ProPAT.
Requirements:
- 1-2 years' experience working as a medical assistant, office assistant, or other clinical/equivalent experience.
- High School Diploma, GED, or equivalent experience.
Preferred Qualifications:
- Call center experience is preferred, 1-2 years.
- Prior authorization experience, 1-2 years.
- Associate's degree.
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.
Anticipated Weekly Hours: 40
Time Type: Full-time