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Handle inbound phone calls that include prescription refills, order status, and insurance coverage. Pharmacy Technician license/certificate and customer service experience are required. Founded in 1850 but incorporated in 1982, Aetna provides high-quality healthcare and protects consumers financially from health-related risks. In 2018, Aetna joined CVS Health, embarking on a mission to offer an innovative new healthcare model that enables better health at a lower cost.
CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CPT. The American Medical Association does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product.
Customer Service Representative / Auftragssachbearbeiter (m/w/d)
Will address health indicators, conduct assessments, coordinate activities and resolve issues. Bachelor's degree and 3+ years' related experience required. All services deemed "never effective" are excluded from coverage. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. Visit the secure website, available through , for more information. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search."
Collaborate across teams, report analytical findings, make recommendations and analyze and synthesis high volumes of complicated data into significant insights and current data. Needs a bachelor's degree and five years' talent acquisition experience in IT. Collaborate heavily with business leaders, provide creativity and follow best practices in sourcing using CRM and ATS, deliver talent discovery. Be responsible for the Emerging Technology and Audit Automation strategy to deliver a best-in-class audit program. Must have a bachelor's degree, RN, and 5+ years healthcare/managed care experience.
Adobe, Senior AEM Developer - Remote
This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. We want to make it easier for you to live healthier. Join us in a conversation about the future of healthcare.
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It is only a partial, general description of plan or program benefits and does not constitute a contract. In case of a conflict between your plan documents and this information, the plan documents will govern. The Applied Behavior Analysis Medical Necessity Guide helps determine appropriate levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. The ABA Medical Necessity Guide does not constitute medical advice.
WFH job for candidate who will own the specialty benefits automation strategy and vision, maintain an outcome-oriented product roadmap, prioritize features and capabilities, and decide when to deliver software. Will collect requirements, collaborate with team, lead solution development and create business models. High school diploma and 8+ years' related experience required. Design conceptual models, handle clinical initiative planning, ongoing client relationship management, and provide guidance to internal/external partners and vendors. Work remotely during CST or EST and travel to Falls Church, VA or Minneapolis, MN.
New and revised codes are added to the CPBs as they are updated. When billing, you must use the most appropriate code as of the effective date of the submission. Unlisted, unspecified and nonspecific codes should be avoided. This information is neither an offer of coverage nor medical advice.
Aetna offers a wide range of health insurance services and products to over 50 million network members, including medical, pharmacy, dental, behavioral health, disability, and group life plans. The company serves individuals and groups in all 50 states and maintains a healthcare network comprised of more than 1 million healthcare professionals and 5,700 hospitals. You have been redirected to an Aetna International site.
Duties include monitoring team attendance, hiring & managing the performance of team members, compiling performance reviews, and providing support to other departments as needed. Many positions are currently remote due to the COVID 19 pandemic and will be under evaluation moving forward for a return to on-site operations. If you’re interested in applying for a Aetna job, you can visit the company’s website to search for open positions. You can also stop by your local Aetna store and speak to the manager about available positions. Senior Claims Benefit Specialist is needed for a remote role. He/She will review and adjudicate complex, sensitive, and/or specialized claims in accordance with processing guidelines.
Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates . 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. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. Through our health services, insurance plans and community pharmacists, we're pioneering a bold new approach to total health. If you’re looking for a job with great benefits and a stable schedule, Aetna might be the place for you.
Duties include contributing code & tests based on established criteria, breaking down & planing sprint work, writing template files, & monitoring, troubleshooting, & supporting applications in production. The five character codes included in the Aetna Clinical Policy Bulletins are obtained from Current Procedural Terminology (CPT®), copyright 2015 by the American Medical Association . CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. Under certain plans, if more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that certain terms are met.
This is the phone number for the Corporate Contact Center. They do not have access to member accounts but they can provide Aetna Member Services contact information. For your convenience, we recommend that you add your Member Services number to your phone contacts. Under general supervision, and in collaboration with other members of the clinical team, authorizes and reviews utilization of mental health and substance abuse servi...
Aetna Dental Clinical Policy Bulletins are developed to assist in administering plan benefits and do not constitute dental advice. Treating providers are solely responsible for dental advice and treatment of members. Members should discuss any Dental Clinical Policy Bulletin related to their coverage or condition with their treating provider. CVS Health is the leading health solutions company that delivers care in ways no one else can.
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