Health Services Intake Specialist (Remote eligible after onsite training)

Wellmark • Des Moines, IA

1d • Remote

About The Position

The Health Services Intake Specialist works in a call center setting to facilitate care management functions, including eligibility and benefit verification, authorization status inquiries, data collection and documentation, and accurate completion of precertification and notification requests. The position provides administrative support to care management teams and helps meet corporate and department objectives by processing incoming requests promptly, professionally, and courteously.

The role requires six weeks of training at the Des Moines, Iowa office. After successful completion of training, the employee is eligible to work remotely on weekdays or follow a hybrid office/home schedule, based on preference. Remote eligibility and office attendance may change based on business needs; occasional office attendance may be requested for meetings or other important events.

Requirements

• High school diploma or GED.
• At least 1 year of related experience, including customer or provider service experience.
• Experience developing customer relationships by telephone, obtaining necessary information, and accurately documenting conversations.
• Experience in the health insurance or health care industry.
• Experience working in a production environment with production and quality metrics.
• Demonstrated ability to use critical thinking to resolve issues and conflicts while maintaining composure and confidence.
• Ability to prioritize work and meet deadlines.
• Strong written and verbal communication skills and ability to communicate effectively with varying audiences.
• Proficiency with Microsoft Office applications.
• Excellent attendance and punctuality.
• Comfort working in a high-volume, fast-paced call center environment.

Responsibilities

• Verify member eligibility and benefits, as well as provider participation and network status.
• Accurately and promptly document information received by phone, fax, or provider portal in JIVA, following department guidelines.
• Support Nurse Care Managers by manually creating episodes for services and admissions that will be reviewed for medical necessity.
• Create and send letters to providers and/or members communicating authorization request outcomes.
• Manage workload within regulatory turnaround requirements and mandated case-processing timeframes.
• Provide accurate information to members and providers using current guidelines and job aides, and meet established quality assurance and production metrics.
• Interpret and comply with regulatory and accreditation standards, Health Services guidelines, HIPAA requirements, and internal utilization management standards.
• Perform other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED