-Support comprehensive coordination of the National Medical Excellence Program
-Utilizes ASD/ATV/MedCompass and other Aetna systems to build, research and enter member
information in applicable system
-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
-Performs intake of calls from members or providers regarding services via telephone, fax, EDI.
-These duties may include but are not limited to processing referrals, making outreach calls, entering data
-Collaborates with the clinical team, medical directors, claims and contacting staff
-Communicates with the transplant financial coordinator at the transplant center.
-Initiates authorizations in regards to kidney transplants
-Communicates with the member regarding transplant services
-Other duties as assigned
-Ability to communicate with diverse populations
-Ability to collaborate with and work in a team environment
Flexibility and ability to work independently
Prior insurance experience
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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