Hybrid Intake Specialist — Healthcare Claims & Authorizations

WPS Health Solutions; Hampton (VA); Hybrid; USD 23.000 - 32.000; Vollzeit

Benefits dieser Stelle

Remote and hybrid work options

Performance bonus

401(k) match for the first 3% of your薪

Zusammenfassung

WPS Health Solutions in the United States seeks an Intake Specialist to manage inbound/outbound communications, initiate prior authorizations, and document all interactions accurately within required timeframes. You will triage cases to clinical staff and process claims while supporting appeals and authorization workflows.

The role emphasizes accuracy, compliance, and customer service, with hybrid work options and potential remote work in approved states.

Qualifikationen

• Two (2) or more years of experience in healthcare, insurance, or medical office environment; including one (1) or more years communicating with providers and patients.
• Working knowledge of medical terminology.
• Strong verbal and written communication skills with ability to accurately document calls and explain requirements in the determination of authorization status or claim denials.
• Ability to multitask and manage high-volume, fast-paced workflows.
• Detail-oriented with strong organizational skills.
• Analytical thinking and problem-solving capability.
• Proficient use of PC with knowledge of standard software programs.

Aufgaben

• Serve as first point of contact for inbound/outbound calls; gather information and route inquiries appropriately.
• Initiate prior authorization cases by collecting demographics and verifying eligibility.
• Accurately document all interactions in system(s) within required timeframes.
• Triage and assign cases to appropriate clinical staff based on established guidelines.
• Index and manage clinical documentation within authorization platforms.
• Process claims and support appeals and authorization workflows.
• Draft and issue approval/denial letters within defined timelines.
• Retrieve and respond to voicemails; ensure timely follow-up with providers and customers.
• Research and resolve inquiries, including risk tasks and service tickets.
• Communicate case updates and coordinate with cross-functional teams.
• Monitor and address audit findings; ensure quality and compliance standards are met.
• Maintain confidentiality and adhere to all data privacy and security policies.
• Support provider registration and system-related processes.
• Participate in team meetings, training, and continuous improvement initiatives.
• Assist with documentation of procedures and workflow enhancements.

Kenntnisse

Healthcare terminology

Verbal and written communication

Documentation in systems

Time management

Multitasking

Attention to detail

PC proficiency

Ausbildung

High School Diploma or GED

Jobbeschreibung

WPS Health Solutions in the United States seeks an Intake Specialist to manage inbound/outbound communications, initiate prior authorizations, and document all interactions accurately within required timeframes. You will triage cases to clinical staff and process claims while supporting appeals and authorization workflows.

The role emphasizes accuracy, compliance, and customer service, with hybrid work options and potential remote work in approved states.