Remote - Intake Specialist I - R6398

Job Summary
Intake Specialist I is a provider oriented role that is responsible for the intake of all authorization requests received via various methods into the Utilization Management department. The Intake Specialist I handles requests from providers, assists with reviewing authorization details, requirements or updates. The Intake Specialist I role processes all requests into our systems for medical review as well as contacting the provider if additional and or clinical information is required.
Essential Functions

• Maintain knowledge and understanding of all processes and procedures for assigned market
• Adhere to all departmental and company policies and procedures
• Convert information obtained from providers/members, (received via fax, phone, portal or mail) into electronic records while verifying member eligibility, provider network status, and benefit coverage
• Provide authorization information to provider, facilities and/or members
• Cross train interdepartmentally for all Medicaid and Marketplace products
• Collaborate across company departments to assist with issues, overrides, and questions
• Perform any other job related instructions, as requested
• Initiate process for routing prior authorizations requiring medical necessity review by clinical care reviewer
• Assist Clinical team as directed to ensure requests for authorization that require clinical review are received and processed timely
• Maintain awareness of current workload aging and respond with appropriate sense of urgency
• Expectation to meet department standards and goals
• Communicate with providers regarding prior authorization requests and troubleshoot issues from providers
• Review requests and send fax back for ineligible members, duplicate requests and items not covered by medical benefit
• Facilitate the authorization of benefits for participating and out-of-network providers including completion of appropriate forms that are distributed to physicians’ offices, provider relations and the generation of approval letters
• Ensure all methods of inquiries (fax, e-mail, phone and provider portal) and submissions are addressed within the state mandated timeframes
• Place prior authorizations when approval is appropriate per SOP in the medical management systems
• Facilitate inbound and outbound contact with providers to obtain any and all additional information that may be required for UM processes (new provider submissions, newborn notifications, etc.)

Education And Experience

• High School Diploma or equivalent required
• Minimum of one (1) year of clinical and/or insurance experience, or related healthcare is preferred
• Managed care experience preferred

Competencies, Knowledge And Skills

• Critical listening and thinking skills
• Attention to detail
• Computer proficiency with knowledge and experience with Microsoft Office in a Windows based environment
• Professional phone etiquette
• Decision making/problem solving
• Ability to work independently and within a team environment
• Ability to accurately communicate summary information in a written format
• Proper grammar usage
• Communication skills
• Ability to analyze information
• Knowledge of behavioral health systems
• Customer service oriented
• Change resiliency

Licensure And Certification

• Medical Terminology Certificate is preferred

Working Conditions

• Position requires the flexibility to work weekends and/or holidays, as needed
• General office environment; may be required to sit or stand for extended periods of time

Compensation Range
$33,200.00 - $53,000.00
Compensation Type
Hourly