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Intake Specialist - Remote
The Intake Specialist will be responsible for entering requested authorization of health care services received via telephone, internet, and fax, sorting and identifying incoming requests. The Intake Specialist will be responsible for following up with providers to obtain clinical information of UM requests. This role may also work with members on redirecting to in-network providers as per health plan coverage guidance. Duties will include verifying plan coverage/PCP, securing patient demographics, requesting physician, current health status including clinical history/physical information, and requested procedures. The Intake Specialist will be responsible for recording authorization information into the database accurately and efficiently and will utilize computer software to input data. The Intake Specialist will be responsible for reviewing, triaging, and processing authorizations for accuracy and completeness of the information within the database in accordance with all compliance and regulatory requirements. The Intake Specialist will communicate authorization information to appropriate individuals within the specified timeframe, inclusive of internal and external Excellent customer service in handling any internal or external communications * required for inbound and outbound calling from and to providers/ and or members. The Intake Specialist will effectively communicate results to management, internal and external clients, and maintain a positive attitude while working in a dynamic, fast-paced environment.
Major Work Activities
Authorization Request Processing:
Perform a high level of data entry. Ensure the overall data integrity of documents received and entered into the computer system
Provides timely oral and /or written notification of determination to provider and member
Responsible for processing all Out of Preferred Network and Out of Network (OOPN/OON) requests, inclusive of the redirection process and preparation of denials
Supports UM Clinical staff in obtaining clinical information, the status of requests, and status of admission/discharge
Responsible for following non-clinical algorithms, network tier structure/exceptions, and preauthorization requirement by the health plan for initial preauthorization of services
Responsible for following all compliance and regulatory requirements for turn-around time, notification to provider/member, and accuracy/completeness
Demonstrate a high level of critical thinking and detail orientation
Handle a high level of inbound and outbound phone calls with excellent customer service. Be responsible for meeting call metrics set by the health plan to include the length of the call, length of answer time, and number of calls taken within a specific period
Responsible for supporting any assigned special projects pertaining to UM functions, customer service, and utilization management
Performs other duties as assigned
Associate degree or equivalent education and/or work experience.
Required Licensure/Certification Regulatory
Annual Flu Vaccine
1 year full-time in a healthcare office setting.
Required Knowledge, Skills, and Abilities
Proficiency in personal software applications, word processing, spreadsheet graphics, and database programs including Microsoft Word, Excel, Access, PowerPoint, Outlook, etc.
Working knowledge and ability to apply professional standards of practice in a work environment.
Knowledge of specific regulatory managed care requirements.
Data entry accuracy.
Excellent typing skills and phone etiquette.
Time: Full time
Updated: 9/28/2021 8:54:56 AM