Aetna Inbound / Outbound Queue Associate in Louisville, Kentucky

Req ID: 46310BR

POSITION SUMMARY

Supports comprehensive coordination of medical services including intake, screening and referrals to Aetna Medical Services Program. Promotes and supports quality effectiveness of Healthcare services.

Fundamental Components:

Performs intake of calls from members or providers regarding services via telephone and fax.

Utilizes QNXT and ProPat 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, coverage of benefits and verification of benefits.

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.

Protects the confidentiality of member information and adheres to company policies regarding HIPPA.

Supports the administration of the precertification process in compliance with various laws and regulations, including 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.

Work requires visual acuity to perform close inspection of written and computer generated documents as well as a PC monitor. Sedentary work involving significant periods of sitting, talking, hearing and keying.

BACKGROUND/EXPERIENCE desired:

Prefer 2-4 years experience as a medical assistant, office assistant or other clinical experience.

Call Center experience is preferred.

EDUCATION

The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.

FUNCTIONAL EXPERIENCES

Functional - Customer Service/Call center monitoring & analysis - Inbound calls - call center location/

REQUIRED SKILLS

Service/Working Across Boundaries/FOUNDATION

Technology/Leveraging Technology/FOUNDATION

ADDITIONAL JOB INFORMATION

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Job Function: Health Care