Remote Care Management Intake Specialist

Wellmark Blue Cross and Blue Shield; Des Moines (IA); Hybrid; USD 25.000 - 30.000; Vollzeit

Zusammenfassung

Wellmark Blue Cross Blue Shield is seeking a Health Services Intake Specialist to support care management in a call center. You will verify eligibility and benefits, document interactions, and assist Nurse Care Managers by creating service episodes for medical necessity review.

The role emphasizes accuracy, HIPAA compliance, and timely communication with members and providers. Training occurs in Des Moines before potential remote or hybrid work options.

Qualifikationen

• High School Diploma or GED.
• 1+ years of related experience including customer or provider service, with documentation of conversations and health insurance knowledge.
• Experience in a production environment with production & quality metrics.
• Ability to apply critical thinking and maintain composure under pressure.
• Strong written and verbal communication skills for diverse audiences.
• Excellent attendance and punctuality.
• Comfortable in a high-volume, fast-paced call center environment.

Aufgaben

• Verify member eligibility and benefits, and provider participation and network status.
• Document information via phone, fax, or provider portal accurately in JIVA with clear communication.
• Support Nurse Care Managers by creating episodes for services and admissions for medical necessity review.
• Create and send letters to providers and/or members communicating outcomes.
• Manage workload within regulatory turnaround time requirements and mandated timeframes.
• Provide accurate information using up-to-date guidelines and job aids; meet QA and production metrics.
• Demonstrate understanding of regulatory and accreditation standards, HIPAA requirements.
• Comply with regulatory standards and internal guidelines; stay current with utilization management standards.
• Other duties as assigned.

Kenntnisse

Customer service

Communication

Attention to detail

Team collaboration

Organization

Problem solving

Ausbildung

High School Diploma or GED

1+ year healthcare experience

Tools

Microsoft Office

JIVA system

Jobbeschreibung

Wellmark Blue Cross Blue Shield is seeking a Health Services Intake Specialist to support care management in a call center. You will verify eligibility and benefits, document interactions, and assist Nurse Care Managers by creating service episodes for medical necessity review.

The role emphasizes accuracy, HIPAA compliance, and timely communication with members and providers. Training occurs in Des Moines before potential remote or hybrid work options.