Intake Specialist I NICU

CareSource•Indianapolis, IN

12d

About The Position

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

Requirements

High School Diploma or equivalent required
Minimum of one (1) year of clinical and/or insurance experience, or related healthcare is preferred
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

Nice To Haves

Managed care experience preferred
Medical Terminology Certificate is preferred

Responsibilities

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