Inbound Outbound CSR Aetna - Philadelphia, PA 19103 Working At Aetna -- the Value To You What does it mean to work at Aetna? A lot. From programs and benefits that support your financial, physical and emotional health to opportunities to build your knowledge and expand your career, the company makes working here a valuable experience in many ways. 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 providers regarding services via telephone, fax, 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 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, NCQA standards, where applicable, while adhering to company policy and procedures Uses Aetna Systems such as QNXT, ProFAX, ProPAT 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. Work requires visual acuity to perform close inspection of written and computer generated documents as well as a PC monitor. Working environment includes typical office conditions. ADDITIONAL JOB INFORMATION 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. 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. We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Required Skills: Medical Terminology experience (preferred). Excellent written and verbal communication skills. High attention to detail; precise and accurate typing. 1-3 years medical administrative/dental claims insurance experience (preferred). Familiarity with various databases, spreadsheets, Quick-Save, MS Excel and MS Word proficient. 1-3 years Call Center experience (preferred). 1-3 years Customer Service (preferred).
Posted on: Wed, 03 Dec 2014 04:31:03 +0000
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