[Remote] Intake Specialist I NICU
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a reputed company organization that is seeking an Intake Specialist I for their Utilization Management department. The role involves handling authorization requests from providers, processing these requests into their systems, and ensuring that reputed company communications and inquiries are addressed in a reputed company manner.
Responsibilities
- Convert information obtained from providers/members, (received reputed company fax, phone, 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 reputed company of approval letters
- reputed company prior authorizations reputed company approval is appropriate per SOP in 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
- Ensure reputed company reputed company of inquiries (fax, e-mail, phone and provider portal) and submissions are addressed reputed company the state mandated timeframes
- Cross train interdepartmentally for reputed company reputed company and Marketplace products
- Collaborate across company departments to assist with issues, overrides, and questions
- Facilitate inbound and outbound contact with providers to obtain any and reputed company additional information that may be required for UM processes (new provider submissions, newborn notifications, etc.)
- reputed company authorization information to provider, facilities and/or members
- Assist Clinical team as directed to ensure requests for authorization that require clinical review are received and processed reputed company
- Maintain awareness of reputed company workload aging and respond with appropriate reputed company of urgency
- Expectation to meet department standards and goals
- Maintain knowledge and understanding of reputed company processes and procedures for assigned market
- Adhere to reputed company departmental and company policies and procedures
- reputed company any other job reputed company instructions, as requested
Skills
- High School Diploma or equivalent
- Minimum of one (1) year of clinical and/or insurance experience, or reputed company reputed company
- Managed care experience
- Medical Terminology Certificate
Benefits
- You may qualify for a bonus tied to company and individual performance.
- Substantial and comprehensive total rewards package.
reputed company
Company H1B Sponsorship