Intake Specialist II

Job Summary:

Intake Specialist II is a provider oriented role that is responsible for the intake of all authorization requests received via various methods into the Utilization Management department. The Intake Specialist role handles incoming requests from providers, assists with reviewing authorization details, requirements or updates. The Intake Specialist II role processes all requests into our systems for medical review as well as contacting the provider/member if additional and or clinical information is required.

Essential Functions:

Convert information obtained from providers/members, (received via fax, phone, provider portal or mail) into electronic records while verifying member eligibility, provider network status, and benefit coverage

Review requests and send fax back for ineligible members, duplicate requests and items not covered by medical benefit

Facilitate the authorization of benefits for participating and out-of-network providers including completion of appropriate forms that are distributed to physicians’ offices, provider relations and the generation of approval letters

• Place prior authorizations when approval is appropriate per SOP into the medical management systems
• Initiate process for routing prior authorizations requiring medical necessity review by clinical care reviewer
• Communicate with providers regarding prior authorization requests and troubleshoot issues from providers

Provide authorization information to provider, facility and/or member.

• Assist Clinical team as directed to ensure requests for authorization that require clinical review are received and processed timely
• Maintain awareness of current workload aging and respond with appropriate sense of urgency
• Expectation to meet department standards and goals
• Collaborate across company departments to assist with issues, overrides, and questions
• Maintain knowledge and understanding of all processes and procedures for multiple markets
• Sufficiently cross-trained in multiple markets and products
• Adhere to all departmental and company policies and procedures
• Perform any other job related instructions, as requested

Education and Experience:

• High School Diploma or equivalent required
• Minimum of eighteen (18) months of clinical and/or insurance experience, or related healthcare education or certification (i.e. STNA, MA, etc.) is required
• Managed care experience preferred

Competencies, Knowledge and Skills:

• Computer proficiency with knowledge and experience with Microsoft Office in a Windows based environment
• Ability to analyze information
• Communication skills
• Ability to work independently and within a team environment
• Attention to detail
• Proper grammar usage
• Critical listening and thinking skills
• Professional phone etiquette
• Customer service oriented
• Decision making/problem solving
• Change resiliency
• Knowledge of behavioral health systems
• Ability to accurately communicate summary information in a written format

Licensure and Certification:

Medical Terminology Certificate is preferred

Working Conditions:

General office environment; may be required to sit/stand for long periods of time

Position requires the flexibility to work weekends and/or holidays, as needed