Senior Intake Coordinator

Highmark Inc. • Buffalo, NY

36d • Onsite

About The Position

JOB SUMMARY This job captures all inbound phone inquires for utilization management review from providers and pharmacies. The incumbent assesses the verbal request, critically thinks through the inquirer's concerns which may require research to fulfill the call, such as verifying benefit coverage, creation of a prior authorization case in Highmark's Utilization Management system for Prior Authorization clinical review, status research, etc. Ensures all accurate information is verified and entered at the onset of the process to ensure adherence to all regulatory compliance requirements and service level agreements. This role may be required to make outbound calls, triage cases, and/or build cases if inventory levels require support. ESSENTIAL RESPONSIBILITIES Handle all inbound phone requests from providers or pharmacy for all inbound Prior Authorization requests. Use multiple software systems and various resource sites to determine member plans and requirements while gathering all appropriate documentation including verification of benefit eligibility. Ensure conversation highlights are captured within the system. If required, build cases in the utilization management system. Utilize critical thinking to ensure call is being appropriately responded to while gathering all required documentation. Appropriately evaluate call and determine if de-escalation is required. Ensure accuracy of data entry to prevent compliance and/or downstream process issues. Other duties as assigned or requested

Requirements

• High School Diploma/GED
• 3 years of customer service experience
• 1 year of healthcare industry experience
• Possess good written and oral telephonic communication skills
• Ability to navigate through multiple systems simultaneously
• Knowledge of administrative and clerical procedures and systems such as word processing, managing files and digital fax
• Ability to interact well with peers, supervisors, and customers
• Problem-Solving
• Knowledge of principles and processes for providing customer service. This includes customer needs assessment, meeting quality standards for services

Responsibilities

• Handle all inbound phone requests from providers or pharmacy for all inbound Prior Authorization requests. Use multiple software systems and various resource sites to determine member plans and requirements while gathering all appropriate documentation including verification of benefit eligibility. Ensure conversation highlights are captured within the system. If required, build cases in the utilization management system.
• Utilize critical thinking to ensure call is being appropriately responded to while gathering all required documentation. Appropriately evaluate call and determine if de-escalation is required.
• Ensure accuracy of data entry to prevent compliance and/or downstream process issues.
• Other duties as assigned or requested

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees