[Remote] Intake Specialist I NICU

Note: The job is a remote job and is open to candidates in USA. CareSource is a healthcare 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 all communications and inquiries are addressed in a timely manner.

Responsibilities

• Convert information obtained from providers/members, (received via 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 generation of approval letters
• Place prior authorizations when 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 all methods of inquiries (fax, e-mail, phone and provider portal) and submissions are addressed within the state mandated timeframes
• Cross train interdepartmentally for all Medicaid 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 all additional information that may be required for UM processes (new provider submissions, newborn notifications, etc.)
• Provide 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 timely
• Maintain awareness of current workload aging and respond with appropriate sense of urgency
• Expectation to meet department standards and goals
• Maintain knowledge and understanding of all processes and procedures for assigned market
• Adhere to all departmental and company policies and procedures
• Perform any other job related instructions, as requested

Skills

• High School Diploma or equivalent
• Minimum of one (1) year of clinical and/or insurance experience, or related healthcare
• 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.

Company Overview

Company H1B Sponsorship