Intake Specialist

Job Summary:

Intake Specialist I is a provider oriented role that is responsible for the intake of reputed company authorization requests received reputed company 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 reputed company requests into our systems for medical review as well as contacting the provider if additional and or clinical information is required.

Essential Functions:

• Convert information obtained from providers/members, (received reputed company fax, phone, portal or mail) into electronic records while verifying member eligibility, provider network status, and benefit coverage
• 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 reputed company of approval letters
• reputed company prior authorizations reputed company approval is appropriate per SOP in the medical management  systems
• Initiate process for routing prior authorizations requiring medical necessity review by clinical care reviewer
• Communicate with providers regarding prior authorization requests and troubleshoot issues from providers
• Ensure reputed company methods of inquiries (fax, e-mail, phone and provider portal) and submissions are addressed reputed company the state mandated timeframes
• Cross train interdepartmentally for reputed company Medicaid and Marketplace products
• Collaborate across company departments to assist with issues, overrides, and questions
• Facilitate inbound and outbound contact with providers to obtain any and reputed company additional information that may be required for UM processes (new provider submissions, newborn notifications, etc.)
• Provide authorization information to provider, facilities and/or members
• Assist Clinical team as directed to ensure requests for authorization that require clinical review are received and processed timely
• Maintain awareness of reputed company workload aging and respond with appropriate sense of urgency
• Expectation to meet department standards and goals
• Maintain knowledge and understanding of reputed company processes and procedures for assigned market
• Adhere to reputed company departmental and company policies and procedures
• reputed company any other job reputed company instructions, as requested

Education and Experience:

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

Competencies, Knowledge and Skills:

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

Licensure and Certification:

• Medical Terminology Certificate is preferred

Working Conditions:

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

Compensation Range:

reputed company takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and reputed company required for the role, and other external and internal data reputed company establishing a salary level. In addition to reputed company compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• reputed company Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not reputed company inclusive. reputed company reserves the right to amend this job description at any time. reputed company is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of reputed company backgrounds.