Intake Specialist II

This is a fully remote position, open to applicants in Ohio.

📋 Description

• Transform information received from providers and members through fax, phone, provider portal, or mail into electronic records while confirming member eligibility, provider network status, and benefit coverage.

• Assess requests and return faxes for ineligible members, duplicate submissions, and items excluded from medical benefits.

• Manage the authorization of benefits for both participating and out-of-network providers, including completing necessary forms and creating approval letters.

• Initiate prior authorizations when appropriate approval is warranted according to standard operating procedures within medical management systems.

• Start the process for routing prior authorizations that necessitate a medical necessity review by a clinical care reviewer.

• Engage with providers concerning prior authorization requests and resolve any provider-related issues.

• Relay authorization details to providers, facilities, and/or members.

• Support the Clinical team to ensure timely receipt and processing of requests requiring clinical review.

• Oversee workload aging and respond with suitable urgency.

• Achieve departmental standards and objectives.

• Collaborate with various company departments on issues, overrides, and inquiries.

• Keep abreast of processes and procedures across multiple markets.

• Participate in cross-training across various markets and products.

• Comply with departmental and company policies and procedures.

• Execute other job-related tasks as assigned.

⛳️ Requirements

• A High School Diploma or equivalent is mandatory.

• At least eighteen (18) months of clinical and/or insurance experience, or relevant healthcare education or certification (such as STNA, MA, etc.) is required.

• Previous managed care experience is preferred.

• Proficiency in computer skills, with knowledge and experience in Microsoft Office within a Windows environment.

• Capability to analyze information effectively.

• Ability to work autonomously as well as part of a team.

• Strong attention to detail.

• Correct grammar usage is essential.

• Possess critical listening and thinking abilities.

• Maintain professional phone etiquette.

• Customer service-oriented mindset.

• Strong decision-making and problem-solving skills.

• Resilient to change.

• Familiarity with behavioral health systems.

• Ability to communicate summary information accurately in writing.

• A Medical Terminology Certificate is preferred.

• Willingness to work weekends and/or holidays, as necessary.

🏝️ Benefits

• Bonus opportunities linked to company and individual performance may be available.

• A substantial and comprehensive total rewards package.

• Option for remote work arrangements.

• Flexibility to work weekends and/or holidays as needed.