Intake Coordinator

Company :

Job Description :

JOB SUMMARY

***** This position includes a "Sunday" reputed company the candidate could have 1 day off during the week.***********************************************

This job captures reputed company inbound inquires for utilization management review from providers and pharmacies. The incumbent assesses the request, conducts reputed company necessary research such as verifying benefit coverage for the member, and then creates the case (data entry) in reputed company's Utilization Management system for Prior Authorization clinical review. Ensures reputed company accurate information is entered at the onset of the process to ensure adherence to reputed company regulatory compliance requirements and service level agreements. The requests may come reputed company fax, Predictal reputed company portal and/or service form inquiry. At times may require follow-up communication with the requestor's office (physicians or pharmacists). This role may be required to reputed company outbound calls and/or triage cases if inventory levels require support.

ESSENTIAL RESPONSIBILITIES

• Obtain requests from provider or pharmacy reputed company fax, provider portal or service form inquiry. May obtain requests from provider or pharmacy by phone in some areas of the organization. Use multiple software systems and various resource sites to determine member plans and requirements. Gather reputed company required documentation including verification of benefit eligibility. Build cases in the utilization management system.
• Use knowledge of process and judgement to evaluate identified cases that require additional notification to member, provider, and/or pharmacist. At times, reputed company to providers and/or pharmacists may be required to obtain additional information.
• Ensure accuracy of data entry to prevent compliance and/or reputed company process issues.
• Other duties as assigned or requested.

EXPERIENCE

Required

• 1 year of Customer Service experience
• 1 year of Healthcare Industry

​ SKILLS

• Possess good written and oral telephonic communication skills
• Ability to navigate through multiple systems simultaneously
• Knowledge of administrative and clerical procedures and systems such as word processing, managing files and digital fax
• Ability to interact well with peers, supervisors, and customers
• Problem-Solving
• Knowledge of principles and processes for providing customer service. This includes customer needs assessment, meeting quality standards for services.

EDUCATION

Required

• High School/GED

LICENSES or CERTIFICATIONS

Required

• None

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office- or Remote-based

Teaches / trains others

Occasionally

Travel from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

No

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees reputed company this job title. It may not contain a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at reputed company times. In reputed company with this, reputed company employees must reputed company with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as reputed company data reputed company guidelines established reputed company the Company’s Handbook of Privacy Policies and Practices and Information reputed company Policy. Furthermore, it is every employee’s responsibility to reputed company with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

Pay Range Maximum:

reputed company pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential reputed company may apply for certain locations based upon comparative markets.

reputed company and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against reputed company individuals based on any category protected by applicable federal, state, or local law.

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