Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.Position Summary
Performs intake of calls from members/providers regarding Infertility treatment services via telephone, fax, and EDI (Availity system) requests.
Provides support services for members/providers of Aetna Infertility medical benefits by answering telephone calls, researching information, and assisting in solving issues.
Utilizes ATV/Med Compass, ASD and other Aetna systems to research and enter member benefit plan information.
Responsible for initial review and triage of National Infertility Unit precertification requests.
Screens requests for appropriate referral to medical services staff. Approve/Deny services that do not require a medical review, in accordance with the benefit plan information.
Performs non-medical research including eligibility verification, COB, and benefits verification.
Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g.,health care providers, and health care team members respectively)
Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
Promotes communication on behalf of members/providers, 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 and coordinate with National Infertility Unit clinical staff when necessary, nurses, medical directors, etc.
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 Med Compass, Plan Sponsor Profile Pages, ePublishing (Plan Booklets), HRP
Required Qualifications
Experience with Aetna Systems: ATV, Med Compass.
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.
Ability to perform sedentary work involving significant periods of sitting, talking, hearing and keying.
Preferred Qualifications
Experience in or knowledge of infertility terminology and treatments
2-4 years experience as a medical assistant, office assistant or other clinical experience.
Experience with or knowledge of Precertification processes
EducationHigh School Diploma or G.E.D.Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$18.50 - $42.35This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.For more detailed information on available benefits, please visit Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)We anticipate the application window for this opening will close on: 03/02/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.