Inbound Outbound Queue Associate – Must reside in Oklahoma
Core
Supports comprehensive coordination of medical services including intake, screening, and referrals to Aetna Better Health via telephone, fax, and EDI.
Role type
Inbound/Outbound Queue Associate (Medical Services Coordination)
Builds
Medical service authorizations and referrals for Aetna Better Health members
Domain
Health Insurance / Medical Administration
Required skills
Medical assistant or clinical experience, Eligibility verification, Benefits verification, Non-medical research, Data entry, Outbound calling, System navigation (Aetna systems)
Preferred skills
Call center experience, Prior authorization experience
Technologies
Aetna Systems (MedCompass, QNXT, ProFAX, ProPAT)
Responsibilities
Perform intake of calls from members or providers regarding services, Screen requests for appropriate referral to medical services staff, Approve services that do not require a medical review, Perform non-medical research including eligibility verification, COB, and benefits verification, Place outbound calls to providers to provide information or obtain clinical information for approval of medical authorizations, Maintain accurate and complete documentation of required information, Communicate with Aetna Case Managers, Nurses, and Medical Directors.
Seniority
Entry-level to Junior