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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 treatments2-4 years experience as a medical assistant, office assistant or other clinical experience.Experience with or knowledge of Precertification processes

Education
High School Diploma or G.E.D.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$18.50 - $42.35

This 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. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 06/18/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.