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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.