Position Outline

- Upholds extensive coordination of clinical benefits including admission, screening to Aetna Clinical benefits Projects.

-Advances/upholds quality viability of Medical care Administrations.

-Performs admission of calls from individuals or suppliers with respect to administrations by means of phone, fax, EDI.

-Uses MedCompass/ATV and other Aetna framework to construct, research and enter part data.

-Evaluates demands for proper reference to clinical benefits staff.

-Endorse administrations that don't need a clinical survey as per the advantage plan.

-Performs non-clinical exploration including qualification check, COB, and advantages confirmation.

-Keeps up with precise and complete documentation of required data that meets risk the board, administrative, and license prerequisites.

-Advances correspondence, both inside and remotely to improve viability of clinical administration administrations (e.g., guarantee heads, Plan Supporters, and outsider payers as well as part, family, and medical care colleagues individually)

-Safeguards the secrecy of part data and sticks to organization approaches in regards to privacy

Speak with Aetna Caseworkers, while handling exchanges for individuals dynamic in this Program-Upholds the organization of the precertification cycle in consistence with different regulations and guidelines, URAQ and additionally NCQA norms, where material, while complying to organization strategy and methodology.

-Inactive work including huge times of sitting, talking, hearing and keying.

-Work requires visual sharpness to perform close examination of composed and PC produced records as well as a PC screen.

-Working climate incorporates normal office conditions.

Required Capabilities

- 2 or more long stretches of call focus experience required

Favored Capabilities

- 2 or more years experience as a clinical colleague, office collaborator or other

Instruction

• Secondary School Certificate or identical GED

Job Benefits:

• Health Benefits: Because Aetna Is A Health Insurance Company, It Generally Offers Comprehensive Health Benefits, Including Health, Dental, And Vision Insurance, To Eligible Employees And Dependents.
• Wellness Programs: Aetna Promotes Employee Wellness Through A Variety Of Programs, Which May Include Exercise Groups, Health Challenges, And Resources To Maintain A Healthy Lifestyle.
• 401(K) Retirement Plan: Aetna May Offer A 401(K) Plan That Allows Employees To Save For Retirement Through Tax-Deductible Contributions. Some Companies Also Offer Matching Offers.
• Time Off (PTO): This Can Include Vacation Days, Sick Days, And Statutory Holidays, Allowing Employees To Take Time Off Work While Still Being Paid.
• Flexible Spending Accounts (FSA): These Accounts Allow Employees To Withdraw Pre-Tax Dollars To Cover Medical, Dental And Dependent Care Expenses.
• Life Insurance And Disability Insurance: Aetna Can Provide Life Insurance And Disability Insurance To Help Protect Employees And Their Families Financially.
• Employee Assistance Programs (Eaps): Eaps Provide Support For Personal And Employment Issues, Including Counseling, Legal Assistance, And Financial Planning.
• Professional Development: Aetna Can Provide Professional Development Opportunities Through Training, Courses, And Educational Resources.
• Parental Leave: Maternity And Paternity Leave To Support Employees When They Become Parents.
• Tuition Assistance: Some Companies, Including Aetna, Offer Tuition Reimbursement Or Assistance Programs To Help Employees Continue Their Education.
• Employee Discounts: Discounts On Aetna Health Insurance Plans And Other Potential Products And Services.
• Remote And Flexible Work: Depending On The Service, Aetna May Offer Flexible Work Arrangements Or Remote Work Options.