Medical Intake & Authorization Specialist

Texas Children's Hospital; Bellaire (TX); On-site; USD 42,000 - 60,000; Full time

Job summary

Texas Children's Hospital is seeking a Utilization Management Assistant to join a growing team. You will receive, process and complete data entry of demographic information on referral/authorization requests from providers by fax or phone, assist medical management staff, and provide customer service regarding provider and product information.

Responsibilities include routing calls, accurate data entry of authorizations, confirming eligibility, and educating providers on requirements and

Qualifications

• H.S. Diploma or GED required.
• Some college coursework preferred.
• 2 years managed care, preferably in a medical management department, claims and member service experience.

Responsibilities

• Serves as support to Medical Management Intake Department.
• Primarily responsible for processing initial incoming faxes or phone requests into the intake department, gathering demographic and benefit data.
• Adheres to time frames and turnaround times as evidenced by inter-rater reliability reviews.
• Routes and evaluates calls and faxes to refer to and assign as necessary to other staff.
• Performs data entry of authorization information into systems and/or fax information to originating physicians, facilities, or specialists.
• Implements nuances of product line and regulatory requirements in processing authorization requests including notification requirements.
• Responsible for confirming eligibility for requested authorizations and for requesting member IDs for newborns.
• Educates providers on authorization requirements and Health Plan policies and procedures.
• Receives transfer calls from member services relating to authorization issues or questions.

Skills

Managed care experience

Healthcare/Insurance experience

Customer service

Education

High school diploma or GED

Some college coursework

Job description

Texas Children's Hospital is seeking a Utilization Management Assistant to join a growing team. You will receive, process and complete data entry of demographic information on referral/authorization requests from providers by fax or phone, assist medical management staff, and provide customer service regarding provider and product information.

Responsibilities include routing calls, accurate data entry of authorizations, confirming eligibility, and educating providers on requirements and