Raleigh, North Carolina
Durham, North Carolina
Morristown, New Jersey
Los Angeles, California
Durham, North Carolina
Posted: 21-Jan-25
Location: Temple, Texas
Internal Number: 25001207
JOB SUMMARY
The Intake Coordinator 1 serves as help to the health plan?s Utilization Management teams. The incumbent is accountable for incoming phone communication, managing, triaging, and entering incoming Prior Authorization (PA) requests and notifications of admission. This position completes the initial data entry and assigns the requests to the appropriate clinical team members.
ESSENTIAL FUNCTIONS OF THE ROLE
- Responds to inbound (fax, phone, mail, electronic) communication with from providers and facilities related to utilization review requests and inquiries. Processes phone and electronic authorization requests for medical services by entering them into the utilization management system. Communicates prior authorization status information to providers upon request.
- Accurately captures all member, provider, and medical procedure coding information on authorizations, and routes the request to appropriate clinical personnel to allow for a clinical review for authorization determinations.
- Completes return memoranda when requests are missing required information or requests do not require prior authorization.
- Creates and distributes routine correspondence. Verifies availability of benefit coverage and network status of performing providers and facilities for requested services.
- Performs administrative duties to include researching and responding to departmental inquiries, and filing data. Accountable for updating assigned Standard Operating Procedures.
- Reviews and processes daily facility discharges. Ensures that the discharge dates are aligned with the authorized service dates and escalates discrepencies to the UM clinicians.
KEY SUCCESS FACTORS
- Experience in an office/customer service environment required. Healthcare/managed care experience highly preferred.
- Excellent computer/typing skills, including speed and accuracy.
- Able to maintain a high level of confidentiality in accordance with HIPAA policies and procedures.
- Able to use a multi-line phone system and possesses proper phone etiquette skills.
- Self motivated and coachable.
- Able to follow verbal and written instructions efficiently and accurately.
- Able to work in a fast-paced environment by prioritizing multiple tasks while meeting multiple deadlines.
- Detail oriented.
- Able to work discreetly as well as with others as part of a team.
BENEFITS
Our competitive benefits package includes the following
- Immediate eligibility for health and welfare benefits
- 401(k) savings plan with dollar-for-dollar match up to 5%
- Tuition Reimbursement
- PTO accrual beginning Day 1
Note: Benefits may vary based upon position type and/or level
QUALIFICATIONS- EDUCATION - H.S. Diploma/GED Equivalent
- EXPERIENCE - 2 Years of Experience
