Senior Intake Coordinator

Overview

This job captures all inbound phone inquiries for utilization management review from providers and pharmacies. The incumbent assesses the verbal request, considers the inquirer’s concerns, and may require research to fulfill the call, such as verifying benefit coverage and creating a prior authorization case in Highmark's Utilization Management system for clinical review. The role ensures all accurate information is verified and entered at the onset to meet regulatory compliance 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.

Highmark Inc.

JOB SUMMARY

This job captures all inbound phone inquiries for utilization management review from providers and pharmacies. The incumbent assesses the verbal request, considers the inquirer’s concerns, and may require research to fulfill the call, such as verifying benefit coverage and creating a prior authorization case in Highmark's Utilization Management system for clinical review. The role ensures all accurate information is verified and entered at the onset to meet regulatory compliance 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 all inbound Prior Authorization requests. Use multiple software systems and various resource sites to determine member plans and requirements while gathering all appropriate 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 being appropriately 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/or downstream process issues.
• Other duties as assigned or requested

Required

• High School Diploma/GED

Substitutions

• None

Preferred

• None

Required

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

Preferred

• None

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. This includes customer needs assessment, meeting quality standards for services

None

0% - 25%

Position Type:
Office-Based

Teaches / trains others regularly

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

Works primarily out-of-the-office selling products/services (sales employees)

Physical work site required

Lifting up to 10 pounds

Lifting 10 to 25 pounds

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.

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 confidential information and must comply with HIPAA and data security guidelines described in the company policies.

Pay Range Minimum: $20.31

Pay Range Maximum: $30.12

Base pay is determined by a variety of factors including qualifications, experience, expected contributions, internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations.

Highmark Health and its affiliates prohibit discrimination and are committed to accessibility. For accommodation requests, contact HR Services Online at HRServices.