Intake Specialist II

CareSource Management Services LLC; Ohio; Híbrido; USD 41.000 - 66.000; Jornada completa

Descripción de la vacante

CareSource is seeking an Intake Specialist II to support the Utilization Management department. You will convert provider and member information into electronic records, verify eligibility and benefits, and handle prior authorizations with accuracy and timeliness.

The role requires communication skills, attention to detail, and the ability to work independently or in a team. Experience in managed care is preferred, with flexibility for varied schedules.

Formación

• High School Diploma or equivalent required.
• Minimum 18 months of clinical and/or insurance experience.
• Managed care experience preferred.

Responsabilidades

• Convert information obtained from providers/members into electronic records while verifying eligibility and coverage.
• Review requests and forward for fax back or action for ineligible members or non-covered items.
• Facilitate authorization of benefits for providers including forms and approval letters.
• Place prior authorizations into medical management systems.
• Initiate process for routing prior authorizations requiring medical necessity review.
• Communicate with providers regarding prior authorization requests and troubleshoot issues.
• Provide authorization information to provider, facility and/or member.
• Assist Clinical team to ensure timely processing of authorization reviews.
• Maintain awareness of workload aging and respond with urgency.
• Collaborate across departments to resolve issues and questions.
• Cross-train in multiple markets and products.

Conocimientos

Microsoft Office

Communication skills

Attention to detail

Customer service

Decision making

Teamwork

Educación

High School Diploma

Descripción del empleo

Job Summary: Intake Specialist II is a provider oriented role that is responsible for the intake of all authorization requests received via various methods into the Utilization Management department. The Intake Specialist role handles incoming requests from providers, assists with reviewing authorization details, requirements or updates. The Intake Specialist II role processes all requests into our systems for medical review as well as contacting the provider/member if additional and or clinical information is required.

Essential Functions:

• Convert information obtained from providers/members, (received via fax, phone, provider 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 generation of approval letters
• Place prior authorizations when approval is appropriate per SOP into 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
• Provide authorization information to provider, facility and/or member
• Assist Clinical team as directed to ensure requests for authorization that require clinical review are received and processed timely
• Maintain awareness of current workload aging and respond with appropriate sense of urgency
• Expectation to meet department standards and goals
• Collaborate across company departments to assist with issues, overrides, and questions
• Maintain knowledge and understanding of all processes and procedures for multiple markets
• Sufficiently cross-trained in multiple markets and products
• Adhere to all departmental and company policies and procedures
• Perform any other job related instructions, as requested

Education and Experience:

High School Diploma or equivalent required Minimum of eighteen (18) months of clinical and/or insurance experience, or related healthcare education or certification (i.e. STNA, MA, etc.) is required Managed care experience preferred

Competencies, Knowledge and Skills:

Computer proficiency with knowledge and experience with Microsoft Office in a Windows based environment Ability to analyze information Communication skills Ability to work independently and within 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/stand for long periods of time Position requires the flexibility to work weekends and/or holidays, as needed Compensation Range: $41,200.00 - $66,000.00 CareSource 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 latitude required for the role, and other external and internal data when establishing a salary level. In addition to base 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): Hourly

Organization Level Competencies:

• Fostering a Collaborative Workplace Culture
• Cultivate Partnerships
• Develop Self and Others
• Drive Execution
• Influence Others
• Pursue Personal Excellence
• Understand the Business

CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

#LI-ST1 Brand=CareSource

The CareSource mission is known as our heartbeat. Just as we support our members to be the best version of themselves, our employees are driven by our mission to create a better world for members, stakeholders and providers. We are difference-makers who combine compassionate hearts with our unique business expertise to make every opportunity count. Each claim, each phone call, each consumer-centric decision is a chance to change the world for one member, and our employees look for ways to do that every day. The challenge is, there is no one right way to be the difference and we’re looking for people like you that will rewrite that definition every day. We do what it takes to form creative solutions that make our community and the world just a little better. Discover what it means to be #UniquelyCareSource.