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Website Aetna
Job Description:
Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Job Responsibilities:
- 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 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.
Job Requirements:
- High School Diploma or GED.
- 1-2 years experience working as a medical assistant, office assistant or other clinical experience.
- Call center experience is preferred plus 2-4 years experience working as a medical assistant, office assistant or other clinical experience.
Job Details:
Company: Aetna
Vacancy Type: Full Time
Job Location: Louisville, KY, US
Application Deadline: N/A
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