Clinical Call Center

Job description:

• Managing incoming calls (high call flow environment)
• Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests
• Refers cases requiring clinical review to a Nurse reviewer
• Responsible for the identification and data entry of referral requests into the UM system
• Responds to telephone and written inquiries from clients, providers and Aetna’s internal departments
• Checks benefits for facility-based treatment
• Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.