Posted 3 days ago
Job Description:
Position is remote - Candidates can be located Anywhere in US but candidates in Kansas are preferred (INDICATE LOCATION ON RESUME)
Customer service required - healthcare/call center preferred
**Non safety sensitive - all items must be clear but drug screens are not required**
Customer Service Representative is the face of Aetna and impacts members' service experience by manner of how customer service inquiries and problems via telephone, internet or written correspondence are handled.
Customer inquiries are basic and at times complex nature.
Engages, consults and educates members based upon the members unique needs, preferences and understanding of Aetna plans, tools and resources to help guide the members along a clear path to care.
Experience:
2 years experience.
Strong Attention to detail
Excellent verbal and written communication and interpersonal skills w/ ability to maintain patient confidentiality
Proficient computer skills and the ability to navigate in a Windows based environment
Ability to follow directions, and adapt in dynamic work environment; ability to adapt to change and remain flexible
Ability to work in a high pressure, time sensitive environment
Project a professional business image, through phone interaction as well as internal communications
Demonstrated problem-solving ability and attention to detail
Demonstrated sense of urgency with assignments
Strong organizational skills
Strong telephone skills
Ability to read and understand pharmacy/medical terminology.
Ability to read, analyze and interpret general business correspondence, technical procedures and governmental regulations.
Ability to identify and solve practical problems and deal with a variety of concrete variables in standardized situations.
Ability to perform basic mathematic calculations maybe required
Ability to interpret a variety of work instructions provided through a variety of mediums.
Ability to anticipate needs and resolve issues with urgency
Ability to consistently meet quality and production standards
Displays confidence in the ability to learn complex material
Demonstrates intellectual curiosity through inquiries to ensure deep understanding of the business and deliver accurate results
Position Summary:
The Aetna CD Representative II will work closely with providers to process prior authorization (PA), and drug benefit exception requests on behalf of Aetna as the client and in accordance with Medicare Part D CMS Regulations.
Must apply information [provided through multiple channels] to the plan criteria defined through work instruction.
Research and conduct outreach via phone to requesting providers to obtain additional information to process coverage requests and complete all necessary actions to close cases.
Responsible for research and correction of any issues found in the overall process.
Phone assistance is required to initiate and/or resolve coverage requests.
Escalate issues to Coverage Determinations and Appeals clinical pharmacists and management team as needed.
Must maintain compliance at all times with CMS and department standards.
Position requires schedule flexibility including rotations through nights, weekend and holiday coverage.
Education:
High School Diploma or GED required.
Associates degree in Business, Accounting or equivalent work experience preferred.
About ASK: ASK Consulting is an award-winning technology and professional services recruiting firm servicing Fortune 500 organizations nationally. With 5 nationwide offices, two global delivery centers, and employees in 42 states-ASK Consulting connects people with amazing opportunities.
ASK Consulting is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all associates.