Intake Specialist II

CareSource•Ohio WFH, OH

1d•$41,200 - $66,000

About The Position

The Intake Specialist II is a provider-oriented role within the Utilization Management department, responsible for receiving and processing authorization requests submitted through fax, phone, provider portal, or mail. The role converts request information into electronic records, verifies member eligibility, provider network status, and benefit coverage, and reviews authorization details, requirements, and updates. It processes requests for medical review and contacts providers or members when additional or clinical information is needed. The position facilitates benefit authorizations for participating and out-of-network providers, places prior authorizations when appropriate under standard operating procedures, and routes requests requiring medical necessity review to clinical care reviewers. The Intake Specialist communicates authorization information to providers, facilities, and members, supports timely processing with the Clinical team, and collaborates across departments to address issues, overrides, and questions. The role requires cross-training across multiple markets and products and adherence to departmental and company policies.

Requirements

High school diploma or equivalent.
At least 18 months of clinical and/or insurance experience, or related healthcare education or certification (e.g., STNA or MA).
Computer proficiency, including knowledge and experience with Microsoft Office in a Windows-based environment.
Ability to analyze information.
Communication skills.
Ability to work independently and in a team environment.
Attention to detail.
Proper grammar usage.
Critical listening and thinking skills.
Professional phone etiquette.
Customer-service orientation.
Decision-making and problem-solving skills.
Change resiliency.
Knowledge of behavioral health systems.
Ability to accurately communicate summary information in writing.

Nice To Haves

Managed care experience.
Medical Terminology Certificate.

Responsibilities

Convert information received from providers or members by fax, phone, provider portal, or mail into electronic records while verifying member eligibility, provider network status, and benefit coverage.
Review requests and send fax responses for ineligible members, duplicate requests, and items not covered by the medical benefit.
Facilitate benefit authorizations for participating and out-of-network providers, including completing appropriate forms, distributing them to physicians’ offices and provider relations, and generating approval letters.
Place prior authorizations in medical management systems when approval is appropriate under standard operating procedures.
Initiate routing of prior authorizations requiring medical necessity review to a clinical care reviewer.
Communicate with providers about prior authorization requests and troubleshoot provider issues.
Provide authorization information to providers, facilities, and/or members.
Assist the Clinical team, as directed, to ensure authorization requests requiring clinical review are received and processed in a timely manner.
Monitor workload aging and respond with an appropriate sense of urgency.
Meet department standards and goals.
Collaborate across company departments to assist with issues, overrides, and questions.
Maintain knowledge of processes and procedures across multiple markets and remain sufficiently cross-trained in multiple markets and products.
Adhere to departmental and company policies and procedures.
Perform other job-related instructions as requested.