Behavioral Health- Inbound Outbound Que Associate

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Job Description
Primary Job Duties & Responsibilities:
Follows management-established procedures to execute routine business support tasks for core Inbound and Outbound communications functions, under general supervision.

Develops effective relationships with all team members to effectively progress daily communications to resolve issues and prevent delays in service or responses.

Handles Inbound and Outbound tasks in a manner that operates in full compliance with patient confidentiality policies and regulations.

Maintains accurate and complete documentation of member health information to minimize risk management, while adhering to all regulatory, and accreditation requirements.

Reviews requests for appropriate referral to medical services staff and approves services that do not require a medical review.

Escalates more complex customer/member inbound inquiries to management for more thorough follow-up and resolution.

Takes management direction to properly execute techniques, processes, and responsibilities according to established work area policies and procedures.

 
Documents all Inbound and Outbound phone details into the company database to ensure full collection of customer/patient needs and requirements.

Demonstrates active listening skills while handling customer/patient calls, also exerting compassion and understanding to gain customer/patient trust and loyalty.

Education:
-High school diploma or up to 1 year equivalent experience.

-Prior Relevant Work Experience
-0-1 year

Essential Qualifications:
-Working knowledge of problem solving and decision making skills
 

Available Shift:
-Shift Available: Monday- Friday- 11am- 7:30pm EST
-Training: 8:00 AM - 4:30 PM EST for first 8 weeks
*Some Holidays required*

Position Summary
Inbound Queue Associate - Behavioral Health role is responsible for accepting inbound calls from facilities, providers, and members regarding pre-certification process within Medicare and Commercial Insurance.

Responsibilities to include but limited to the following:
•    Performs intake of calls from members or providers regarding services via telephone, fax, EDI.
•    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.
•    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
•    Other duties and responsibilities as required.

Required Qualifications
•    2 plus years of Customer Service Background
•    2 plus years of Call Center experience

Preferred Qualifications
•    Familiarity with basic medical terminology and concepts used in care management.
•    2-4 years experience as a medical assistant, office assistant or other clinical experience.
•    Effective communication, telephonic and organization skills.
•    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 or equivalent GED
 

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is: