Remote Healthcare Intake Specialist – Auth & Claims

WPS Health Solutions; Columbus (OH); Hybrid; USD 23.000 - 32.000; Vollzeit

Benefits dieser Stelle

Remote and hybrid work options

Performance bonus

401(k) with match

Paid time off

Health insurance

Dental insurance

Telehealth services

Professional development

Zusammenfassung

WPS Health Solutions is seeking an Intake Specialist to manage inbound and outbound communications, ensuring accurate intake, documentation, and routing of cases within Health Services.

You will support prior authorizations, claims processing, including drafting authorization and denial letters, case setup, and triage of tasks while upholding accuracy, compliance and customer service standards.

Qualifikationen

• Two or more years in healthcare, insurance, or medical office environment; including experience communicating with providers and patients.
• Knowledge of medical terminology.
• Strong verbal and written communication skills for documenting calls and explaining authorization/denial decisions.
• Ability to multitask in high-volume, fast-paced workflows.
• Detail-oriented with solid organizational skills.
• Analytical thinking and problem-solving abilities.
• Proficient use of PC with standard software.

Aufgaben

• Serve as first point of contact for inbound/outbound calls and route inquiries appropriately.
• Initiate prior authorization cases by collecting demographics and verifying eligibility.
• Document all interactions in system(s) within required timeframes.
• Triage and assign cases to clinical staff based on 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.
• Respond to voicemails and 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.
• Maintain confidentiality and adhere to data privacy policies.
• Support provider registration and system-related processes.
• Participate in team meetings, training and continuous improvement.
• Assist with documentation of procedures and workflow enhancements.

Kenntnisse

Healthcare experience

Medical terminology

Communication skills

Multitasking

Detail-oriented

Analytical thinking

PC proficiency

Ausbildung

High School Diploma or GED

Jobbeschreibung

WPS Health Solutions is seeking an Intake Specialist to manage inbound and outbound communications, ensuring accurate intake, documentation, and routing of cases within Health Services.

You will support prior authorizations, claims processing, including drafting authorization and denial letters, case setup, and triage of tasks while upholding accuracy, compliance and customer service standards.