[Remote] Inbound/Outbound Queue Associate (Must live in Eastern Time Zone) at CVS Health

Virginia, Minnesota, United States

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Not SpecifiedCompensation

Entry Level & New GradExperience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

2-4 years experience as a medical assistant, office assistant or other clinical experience
Must reside in the Eastern Time Zone
High School diploma or equivalent GED

Responsibilities

Promotes/supports quality effectiveness of Healthcare Services
Performs intake of calls from members or providers regarding services via telephone, fax, EDI
Utilizes eTUMS and other Aetna systems to build, research and enter member information
Screens requests for appropriate referral to medical services staff. Approve 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 (e.g., claim administrators, Plan-Sponsors, and third party payers as well as member, family, and health care team members respectively)
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, URAQ and/or NCQA standards, where applicable, while adhering to company policy and procedures
Places outbound calls to providers under the direction of Medical-Management Nurses to obtain clinical information for approval of medical authorizations
Uses Aetna Systems such as QNXT, ProFAX, ProPAT, and Milliman Criteria
Communicates with Aetna Nurses and Medical Directors, when processing transactions for members active in this Program

Skills

Key technologies and capabilities for this role

eTUMSEDIeligibility verificationbenefits verificationprecertificationintake screeningmedical referralscase management

Questions & Answers

Common questions about this position

What are the required qualifications for this Inbound/Outbound Queue Associate role?

Candidates need 2-4 years of experience as a medical assistant, office assistant, or other clinical experience, and must reside in the Eastern Time Zone. A High School diploma or equivalent GED is required.

What is the work schedule for this position?

The shift is Monday-Friday, 8:00AM-5:00PM EST, with anticipated weekly hours of 40 for this full-time role.

Is this a remote position, and what are the location requirements?

Candidates must reside in the Eastern Time Zone, but specific details on remote or office work are not provided. The working environment includes typical office conditions with sedentary work.

What is the salary or compensation for this role?

This information is not specified in the job description.

What preferred experience would make me a stronger candidate?

Call center experience is preferred, in addition to the required 2-4 years of clinical or office assistant experience.

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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