Inb/Outb Queue Associate - CVS : Job Details

Supports comprehensive coordination of medical services including intake, screening, and referrals to Aetna Better Health.- Promotes/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.- Approve services that do not require a medical review in accordance with the benefit plan.- Performs non-medical research including eligibilityverification, 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 respec...Associate, Medical Director, Processing, Office Assistant, Retail