Job Summary:
Intake Specialist I 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 I handles requests from providers, assists with reviewing authorization details, requirements or updates. The Intake Specialist I role processes all requests into our systems for medical review as well as contacting the provider if additional and or clinical information is required.
Essential Functions:
- Convert information obtained from providers/members, (received via fax, phone, 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 in 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
- Ensure all methods of inquiries (fax, e-mail, phone and provider portal) and submissions are addressed within the state mandated timeframes
- Cross train interdepartmentally for all Medicaid and Marketplace products
- Collaborate across company departments to assist with issues, overrides, and questions
- Facilitate inbound and outbound contact with providers to obtain any and all additional information that may be required for UM processes (new provider submissions, newborn notifications, etc.)
- Provide authorization information to provider, facilities and/or members
- 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
- Maintain knowledge and understanding of all processes and procedures for assigned market
- 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 one (1) year of clinical and/or insurance experience, or related healthcare is preferred
- 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 or stand for extended periods of time
- Position requires the flexibility to work weekends and/or holidays, as needed
Compensation Range:
$35,900.00 - $57,300.00
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
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
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