CVS is Hiring Work from Home in the PST Right Now!

CVS is hiring work from home in some states!

CVS is the largest pharmacy chain in the United States! CVS makes over $100 billion every year! CVS is hiring work from home customer service representatives in the pacific time zone!

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Job Description
This position is work at home for candidates residing in Pacific Standard Time Zone.

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 eTUMS and other 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 (e.g., claim administrators, Plan Sponsors, and third party payers as well as member, family, and health care team members respectively) Protects the confidentiality of member information and adheres to company policies regarding confidentiality
Communicate with Aetna Case Managers, when processing transactions for members active in this Program
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 under the direction of Medical Management Nurses to obtain clinical information for approval of medical authorizations
Uses Aetna Systems such as QNXT, ProFAX, ProPAT, and Milliman Criteria
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.

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Background Experience

2-4 years experience as a medical assistant, office assistant or other clinical experience.
High School Diploma or G.E.D.

Additional Job Information
Effective communication, telephonic and organization skills.Familiarity with basic medical terminology and concepts used in care management.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.

Education
High School diploma, G.E.D. or equivalent experience

Percent of Travel Required
N/A