CHAPS Building, THNM-THN Utilization ManagemntCITY:
Exempt: No | FTE: 1.0 (40 hours/week) | Schedule: M-F with every 6th Saturday | On Call: NOJOB SUMMARY:
The Intake Specialist will be responsible for entering requested authorization of health care services received via telephone, internet and fax, sorting and identifying incoming requests. The Intake Specialist will be responsible for following up with providers to obtain clinical information of UM requests. This role may also work with members on redirecting to in network providers as per health plan coverage guidance. Duties will include verifying plan coverage/PCP, securing patient demographics, requesting physician, current health status including clinical history/physical information, and requested procedures. The Intake Specialist will be responsible for recording authorization information into database accurately and efficiently and will utilize computer software to input data. The Intake Specialist will be responsible for reviewing, triaging and processing authorizations for accuracy and completeness of information within the database in accordance to all compliance and regulatory requirements. The Intake Specialist will communicate authorization information to appropriate individuals within the specified timeframe, inclusive of internal and external Excellent customer service in handling any internal or external communications * required for inbound and outbound calling from and to providers/ and or members. The Intake Specialist will effectively communicate results to management, internal and external clients, and maintain a positive attitude while working in a dynamic, fast paced environment.EDUCATION:
Required: College Degree with minimum 2 years in a health care setting or provider organization
*May substitute experience for degree EXPERIENCE:
Required: 1 Year of Full-Time Experience in a Healthcare Office
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