[Remote] Inbound/Outbound Queue Associate Must live in Maryland at CVS Health

Maitland, Florida, United States

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Not SpecifiedCompensation

Entry Level & New GradExperience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Must reside in the State of Maryland
2-4 years experience as a medical assistant, office assistant or other clinical experience
2-4 years of call center experience
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 system 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
Communicate 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

eTUMS

EDI

intake screening

eligibility verification

benefits verification

precertification

medical services coordination

case management

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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