Senior Intake Coordinator

Overview

Company:
Highmark Inc.

Job Description:

JOB SUMMARY — This job captures all inbound phone inquiries for utilization management review from providers and pharmacies. The incumbent assesses the verbal request, researches the inquiry as needed (e.g., verifying benefit coverage, creating a prior authorization case in the Utilization Management system for clinical review, status research). Ensures all accurate information is verified and entered at the onset to ensure compliance with regulatory 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.

• Handle all inbound phone requests from providers or pharmacies for Prior Authorization requests. Use multiple software systems and resource sites to determine member plans and requirements while gathering 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 the call is addressed while gathering all required documentation. Appropriately evaluate the call and determine if de-escalation is required.
• Ensure accuracy of data entry to prevent compliance and downstream process issues.
• Other duties as assigned or requested.

• Required:
  
  High School Diploma/GED

• None

• None

• Required:
  
  3 years of customer service experience
• Required:
  
  1 year of healthcare industry experience

• Required:
  
  None

• 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, including needs assessment and meeting quality standards

Language (Other than English):
None

Travel Required:

0% - 25%

Position Type:
Office-Based

Teaches / trains others regularly:
Frequently

Travel regularly from the office to various work sites or site-to-site:
Rarely

Works primarily out-of-the-office selling products/services (sales employees):
Never

Physical work site required:
Yes

Lifting: up to 10 pounds — Occasionally

Lifting: 10 to 25 pounds — Rarely

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 within this job title. It may not contain a comprehensive inventory of all 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 access to covered information, cardholder data, or other confidential customer information that must be protected at all times. All employees must comply with HIPAA and the company’s privacy policies and information security guidelines.

Furthermore, employees must comply with the company’s Code of Business Conduct and applicable laws, regulations, and policies.

Pay Range Minimum: $20.31

Pay Range Maximum: $30.12

Base pay is determined by a variety of factors including qualifications, experience, and internal equity, and may vary by location. This salary range does not reflect geographic differentials.

Highmark Health and its affiliates prohibit discrimination against qualified individuals and provide accessibility information. For accommodations, contact HR Services Online at HRServices.

Req : J269786