Additionalinformation

Additional Information

All your information will be kept confidential according to EEO guidelines.

Companydescription

Company Description

Jobdescription

Job Description

Principal Accountability:

• Screens information received and refers members to the appropriate provider and/or contacts the provider directly for members.

• Facilitates the authorization process for requests that do not require clinical criteria application or judgment.

• Provides relevant information to members and assists them in resolving Plan related problems when Member Services personnel are not available.

• Acts as a resource to staff for questions related to the prior authorization process.

• Refers unresolved prior authorization process questions to the Lead Intake Specialist.

• Assists the Lead Intake Specialist in identifying, planning and implementing staff training programs.

• Identifies and reports member and provider educational opportunities to the Lead Intake Specialist.

• Accurately answers questions regarding Plan benefits and Utilization Management requirements for members and providers.

• Makes appropriate inquiries to determine potential coordination of benefits and advises appropriate provider and claims staff of same.

• Supports Utilization Management nurses with data entry.

• Performs other duties as assigned.

• Adheres to Select Health and KMHP policies and procedures.

• Supports and carries out the Select Health and Mercy Mission & Values.

Key Competencies/Success Factors:

• Excellent interpersonal and verbal communication skills.

• Attention to detail and confidentiality.

• Patience and a balanced demeanor.

• Professional image.

• Ability to write clear and concise reports.

• Willingness to work any shift.

• Availability for in-service training.

Requirements/Certifications:

REQUIREMENTS:

• High School Diploma / GED

• Proficient PC Skills in a Windows based environment including word processing, spread sheets and working in database programs.

• Proven ability to keep accurate and timely records and documentation according to established processes

• Experience as a medical assistant or role with similar responsibilities

• Experience handling multiple calls or triaging calls

• Medical Terminology, ICD, CPT, and coding experience

Qualifications