Intake Coordinator ID -2590
This job captures all inbound inquires for utilization management review from providers and pharmacies. The incumbent assesses the request, conducts all necessary research such as verifying benefit coverage for the member, and then creates the case (data entry) in Highmark's Utilization Management system for Prior Authorization clinical review. Ensures all accurate information is entered at the onset of the process to ensure adherence to all regulatory compliance requirements and service level agreements. The requests may come via fax, Predictal Availity 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 make outbound calls and/or triage cases if inventory levels require support.
ESSENTIAL RESPONSIBILITIES
- Obtain requests from provider or pharmacy via 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 all 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, outreach to providers and/or pharmacists may be required to obtain additional information.
- Ensure accuracy of data entry to prevent compliance and/or downstream 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
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Remote Customer Support, $45/hr, No Experience, Part-Time
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Remote Moderator, $40/hr, College Student Friendly, Part-Time
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Remote Phone Job, $45/hr, Part-Time, No Degree Required
Customer Support, $50/hr, Night Job, Remote, No Experience
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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
