Intake Specialist

Job Summary:Intake Specialist I 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 I handles requests from providers, assists with reviewing authorization details, requirements or updates. The Intake Specialist I role processes all requests into our systems for medical review as well as contacting the provider if additional and or clinical information is required.Essential Functions: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 coverageReview requests and send fax back for ineligible members, duplicate requests and items not covered by medical benefitFacilitate 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 lettersPlace prior authorizations when approval is appropriate per SOP in the medical management systemsInitiate process for routing prior authorizations requiring medical necessity review by clinical care reviewerCommunicate with providers regarding prior authorization requests and troubleshoot issues from providersEnsure all methods of inquiries (fax, e-mail, phone and provider portal) and submissions are addressed within the state mandated timeframesCross train interdepartmentally for all Medicaid and Marketplace productsCollaborate across company departments to assist with issues, overrides, and questionsFacilitate 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 membersAssist Clinical team as directed to ensure requests for authorization that require clinical review are received and processed timelyMaintain awareness of current workload aging and respond with appropriate sense of urgencyExpectation to meet department standards and goalsMaintain knowledge and understanding of all processes and procedures for assigned marketAdhere to all departmental and company policies and proceduresPerform any other job related instructions, as requestedEducation and Experience:High School Diploma or equivalent requiredMinimum of one (1) year of clinical and/or insurance experience, or related healthcare is preferredManaged care experience preferredCompetencies, Knowledge and Skills:Computer proficiency with knowledge and experience with Microsoft Office in a Windows based environmentAbility to analyze informationCommunication skillsAbility to work independently and within a team environmentAttention to detailProper grammar usageCritical listening and thinking skillsProfessional phone etiquetteCustomer service orientedDecision making/problem solvingChange resiliencyKnowledge of behavioral health systemsAbility to accurately communicate summary information in a written formatLicensure and Certification:Medical Terminology Certificate is preferredWorking Conditions:General office environment; may be required to sit or stand for extended periods of timePosition requires the flexibility to work weekends and/or holidays, as neededCompensation Range:$35,900.00 - $57,300.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary):HourlyOrganization Level Competencies Fostering a Collaborative Workplace CultureCultivate PartnershipsDevelop Self and OthersDrive ExecutionInfluence OthersPursue Personal ExcellenceUnderstand the Business This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.#LI-JM1

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