Care Coordination Associate: Transplant & Benefits

CVS Health; Georgia; Remote; USD 25,000 - 49,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a detail-oriented professional to support the National Medical Excellence Program by handling inbound calls from the phone queue and coordinating member and provider services. You will use Aetna systems to build, research, and enter member data while performing non-medical research such as eligibility verification and COB.

You will interact with clinical teams, medical directors, and transplant staff to initiate authorizations for kidney transplants and coordinate

Qualifications

• 2+ years’ experience working as a medical assistant, office assistant or other clinical/equivalent experience.
• Computer skills, including Microsoft Office Suite (Specifically Excel)
• Ability to communicate with diverse populations
• Ability to collaborate with and work in a team environment
• Flexibility and ability to work independently

Responsibilities

• Perform intake of calls from providers or members.
• Utilizes Aetna Systems such as MedCompass, HRP, ASD, CEC, and ATV and other Aetna systems to build, research and enter member information.
• Perform non-medical research including eligibility verification, COB, and benefits verification.
• Maintains accurate and complete documentation of required information and meets risk management, regulatory and accreditation requirements.
• Process referrals, make outreach calls, entering data.
• Collaborates with the clinical team, medical directors, claims and contacting staff.
• Communicates with transplant financial coordinator at the transplant center.
• Initiates authorizations regarding kidney transplants in accordance with unit processes.
• Communicates with the member or provider regarding transplant services.
• Build shell cases for transplant, cellular therapy, and gene therapy services request and task to nurse review.
• 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 confidentiality.
• Supports the administration of the precertification process in compliance with various laws and regulations and/or NCQA standards.
• Communicates with Aetna Nurses and Medical Directors when processing transactions for members active in this Program.
• Sedentary work involving significant periods of sitting, talking, hearing, and keying.

Skills

Effective Communication

Team Collaboration

Adaptability

Excel proficiency

Education

High School Diploma or GED

Associate Degree Preferred

Tools

Microsoft Excel

Aetna Systems (MedCompass, HRP, ASD, CEC, ATV)

Job description

CVS Health is seeking a detail-oriented professional to support the National Medical Excellence Program by handling inbound calls from the phone queue and coordinating member and provider services. You will use Aetna systems to build, research, and enter member data while performing non-medical research such as eligibility verification and COB.

You will interact with clinical teams, medical directors, and transplant staff to initiate authorizations for kidney transplants and coordinate