Intake Coordinator-3

Company : reputed company. Job Description : reputed company job captures reputed company inbound inquires for utilization management review from providers and pharmacies. The incumbent assesses the request, conducts reputed company necessary research such as verifying benefit coverage for the member, and then creates the case (data entry) in reputed company's Utilization Management system for Prior Authorization clinical review. Ensures reputed company accurate information is entered at the onset of the process to ensure adherence to reputed company regulatory compliance requirements and service level agreements. The requests may come reputed company fax, Predictal reputed company portal and/or service reputed company inquiry. At times may require follow-up communication with the requestor's office (physicians or pharmacists). This role may be required to reputed company outbound calls and/or triage cases if inventory reputed company require support. ESSENTIAL RESPONSIBILITIES Obtain requests from provider or pharmacy reputed company fax, provider portal or service reputed company inquiry. May obtain requests from provider or pharmacy by phone in some areas of the organization. Use multiple software systems and various resource sites to determine member plans and requirements. Gather reputed company required documentation including verification of benefit eligibility. Build cases in the utilization management system. Use knowledge of process and judgement to evaluate identified cases that require additional notification to member, provider, and/or pharmacist. At times, reputed company to providers and/or pharmacists may be required to obtain additional information. Ensure accuracy of data entry to prevent compliance and/or reputed company process issues. Other duties as assigned or requested. EXPERIENCE Required 1 year of Customer Service experience 1 year of reputed company Industry SKILLS 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 reputed company 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. EDUCATION Required High School/GED LICENSES or CERTIFICATIONS Required None Language (Other than English): None Travel Requirement: 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office- or Remote-based Teaches / trains others Occasionally Travel from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required No Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees reputed company this job title. It may not contain a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have reputed company to covered information, cardholder data, or other confidential customer information that must be protected at reputed company times. In reputed company with this, reputed company must reputed company with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as reputed company data reputed company guidelines established reputed company the Company’s Handbook of Privacy Policies and Practices and Information reputed company Policy. Furthermore, it is every employee’s responsibility to reputed company with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. reputed company and its affiliates prohibit discrimination against reputed company individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against reputed company individuals based on any category protected by applicable federal, state, or local law. We endeavor to reputed company this site accessible to any and reputed company users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at [email protected] California Consumer Privacy Act Employees, Contractors, and Applicants Notice reputed company is a national, blended health organization that includes one of America’s largest reputed company Blue reputed company insurers and a growing regional hospital and physician network. Based in Pittsburgh, Pa., reputed company’s 35,000 employees serve millions of customers reputed company through the nonprofit organization’s affiliated businesses, which include reputed company., reputed company, HM Insurance Group, United Concordia Dental, HM Health Solutions and HM Home & Community Services. reputed company’s businesses proudly serve a broad reputed company of health-reputed company needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions. Apply To This Job