Job Description

Description:

The Aetna CD Representative II will work closely with the Prior Authorization team to process Approval and Denial letters. 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. Must maintain compliance at all times with CMS and department standards. Position requires schedule flexibility including rotations through nights, weekend and holiday coverage. This will be a work from home position. Applicant will need previous MCO/Prior Authorization Experience.

Experience:

2 years experience. 1.Strong Attention to detail 2.Excellent verbal and written communication and interpersonal skills w/ ability to maintain patient confidentiality 3.Proficient computer skills and the ability to navigate in a Windows based environment 4.Ability to follow directions, and adapt in dynamic work environment; ability to adapt to change and remain flexible 5.Ability to work in a high pressure, time sensitive environment 6.Project a professional business image, through phone interaction as well as internal communications 7.Demonstrated problem-solving ability and attention to detail 8.Demonstrated sense of urgency with assignments 9.Strong organizational skills 10.Strong telephone skills 11.Ability to read and understand pharmacy/medical terminology 12.Ability to read, analyze and interpret general business correspondence, technical procedures and governmental regulations. 13.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 14.Ability to interpret a variety of work instructions provided through a variety of mediums 15.Ability to anticipate needs and resolve issues with urgency 16.Ability to consistently meet quality and production standards 17.Displays confidence in the ability to learn complex material 18.Demonstrates intellectual curiosity through inquiries to ensure deep understanding of the business and deliver accurate results

Company Description

Medical Recruitment Strategies (MRS) is a recruiting firm that specializes in the placement of professionals in pharmacies, hospitals, healthcare organizations and life sciences companies. We offer contract and direct hire services and work all over the U.S. Over the last 16 years, we have become a premier provider of talent.