Intake Coordinator

This is a fully remote position, open to applicants in Alabama, +44 more states.

📋 Description

• Handle incoming inquiries related to utilization management review from healthcare providers and pharmacies.

• Evaluate requests and investigate member benefit coverage.

• Generate cases through data entry in Highmark's Utilization Management system for prior authorization clinical evaluation.

• Input accurate data to adhere to regulatory compliance standards and service level agreements.

• Receive requests via fax, provider portal, service form inquiries, and occasionally by phone.

• Utilize various software systems and resource sites to identify member plans and requirements.

• Collect necessary documentation and confirm benefit eligibility.

• Assess cases that require further notification to members, providers, or pharmacists.

• Reach out to providers and pharmacists for additional information when necessary.

• Make outbound calls and manage case triage as inventory levels necessitate support.

• Execute additional duties as assigned.

⛳️ Requirements

• Minimum of 1 year in Customer Service.

• At least 1 year of experience in the Healthcare Industry.

• Strong written and verbal communication skills for phone interactions.

• Ability to operate multiple systems concurrently.

• Familiarity with administrative and clerical processes and systems, including word processing, file management, and digital faxing.

• Capacity to engage effectively with colleagues, supervisors, and clients.

• Proven problem-solving abilities.

• Understanding of customer service principles and processes, including needs assessment and adherence to quality service standards.

• High School diploma or GED.

• Compliance with HIPAA, data security protocols, company policies, codes of conduct, and applicable federal and state regulations is mandatory.

• No licenses or certifications are required.

• Proficiency in English is the only language requirement.

🏝️ Benefits

• Flexible remote work options.

• Competitive base salary.

• Travel requirement ranges from 0% to 25%.