Care Coordination Specialist - Health & Transplant Services

CVS Health; Columbia (SC); Remote; USD 25,000 - 49,000; Full time

Job summary

CVS Health is seeking a detail-oriented Medical Support Associate to assist with intake calls from providers and members. You will utilize Aetna systems such as MedCompass, HRP, ASD, CEC, and ATV to research and enter member data, verify eligibility, COB, and benefits, while maintaining compliant documentation.

You will collaborate with clinical teams and transplant coordinators to process referrals, initiate transplant authorizations, and support precertification processes in line with

Qualifications

• 2+ years experience in medical assistant/office assistant or equivalent.
• Proficient with Microsoft Office, especially Excel.
• Able to communicate with diverse populations.
• Able to collaborate in a team environment.
• Flexible and able to work independently.

Responsibilities

• Performs intake of calls from providers or members.
• Uses Aetna systems to build, research and enter member information.
• Performs non-medical research including eligibility verification, COB, and benefits verification.
• Maintains accurate documentation meeting risk, regulatory and accreditation requirements.
• Handles intake of calls from members/providers via telephone, fax, EDI.
• Processes referrals, outreach calls, data entry as needed.
• Collaborates with clinical team, medical directors, claims and contacts staff.
• Communicates with transplant financial coordinator for transplant services.
• Initiates authorizations for kidney transplants per unit processes.
• Communicates transplant services details to members/providers.
• Build shell cases for transplant, cellular therapy, gene therapy requests for nurse review.
• Promotes internal/external communication to support medical management services.
• Protects confidentiality of member information per company policy.
• Supports precertification process per laws/regulations and NCQA standards.
• Communicates with Aetna nurses and medical directors on transactions.
• Sits for long periods; requires visual acuity for documents.

Skills

Medical assistance

Excel

Team collaboration

Communication

Education

High School Diploma or GED

Associate Degree

Tools

MedCompass

HRP

ASD

CEC

ATV

Job description

CVS Health is seeking a detail-oriented Medical Support Associate to assist with intake calls from providers and members. You will utilize Aetna systems such as MedCompass, HRP, ASD, CEC, and ATV to research and enter member data, verify eligibility, COB, and benefits, while maintaining compliant documentation.

You will collaborate with clinical teams and transplant coordinators to process referrals, initiate transplant authorizations, and support precertification processes in line with