Intake Specialist: Hybrid/Remote Health Authorizations

WPS Health Solutions; Green Bay (WI); Hybrid; USD 23.000 - 32.000; Vollzeit

Benefits dieser Stelle

Remote work options

Hybrid work options

Performance bonus

401(k) with match

Paid time off

Health/Dental/Telehealth Day 1

Professional development

Zusammenfassung

WPS Health Solutions is seeking an Intake Specialist to manage inbound and outbound calls, collect demographics for prior authorizations, document interactions, and triage cases for clinical staff. This role emphasizes accuracy, compliance and exceptional customer service in a healthcare environment.

Responsibilities include processing claims and authorization workflows, drafting approval/denial letters, and maintaining confidentiality while supporting provider registration.

Qualifikationen

• High School Diploma or GED or equivalent experience.
• 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 experience

Communication skills

Multitasking

Detail oriented

Analytical thinking

Computer literacy

Ausbildung

High school diploma

Jobbeschreibung

WPS Health Solutions is seeking an Intake Specialist to manage inbound and outbound calls, collect demographics for prior authorizations, document interactions, and triage cases for clinical staff. This role emphasizes accuracy, compliance and exceptional customer service in a healthcare environment.

Responsibilities include processing claims and authorization workflows, drafting approval/denial letters, and maintaining confidentiality while supporting provider registration.