Aetna Inb/Outb Queue Assoc in Houston, Texas

Req ID: 53546BR

POSITION SUMMARY

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

Fundamental Components:

Performs intake of calls from members or providers regarding services via telephone,fax, EDI. Utilizes ATV and MedCompass systems 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. * Protects the confidentiality of member information and adheres to company policies regarding confidentiality 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 to obtain clinical information for approval of medical authorizations. Communicates with Aetna Nurses and Medical Directors, when processing transactions for members active in this Program.

BACKGROUND/EXPERIENCE desired:

2-4 years experience as a medical assistant, office assistant or other clinical experience. Prior customer service experience preferred. Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members. Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word. Ability to effectively participate in a multi-disciplinary team including internal and external participants. Familiarity with basic medical terminology and concepts used in care management. Effective communication, telephonic and organization skills.

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/Customer service - production environment/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft Word/1-3 Years/

Technical - Desktop Tools/Microsoft PowerPoint/1-3 Years/

REQUIRED SKILLS

Service/Handling Service Challenges/FOUNDATION

Service/Providing Solutions to Constituent Needs/FOUNDATION

Service/Working Across Boundaries/FOUNDATION

DESIRED SKILLS

General Business/Maximizing Work Practices/ADVANCED

Service/Creating a Differentiated Service Experience/ADVANCED

General Business/Communicating for Impact/ADVANCED

ADDITIONAL JOB INFORMATION

Join our Clinical Services team and help shape a new way to support our members. Health insurance is changing and we are testing out a new way to organize our Clinical services team to change how our member and provider communities are supported. In this new model, you will be part of a team tasked to help design and test new ways of working to deliver a better consumer experience. You can influence the future of health care and make a difference!

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 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 candidates'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