Intake Coordinator

2 weeks ago

Baton Rouge LA USA, United States Highmark Health Full time
Job Summary

This role is responsible for capturing all inbound requests for utilization review from providers and pharmacies. The incumbent assesses the request, conducts research to verify benefit coverage, and creates cases in Highmark's utilization management system for clinical review. Ensures accurate information is entered to adhere to regulatory compliance requirements and service level agreements.

Key Responsibilities
  • Obtain requests from providers or pharmacies via phone, fax, or provider portal, and use multiple software systems to determine member plans and requirements.
  • Evaluate cases that require additional notification to members, providers, and/or pharmacists, and contact them by phone to obtain additional information.
  • Ensure accuracy of data entry to prevent compliance and downstream process issues.
  • Perform other duties as assigned.
Requirements
  • High School Diploma/GED
  • 1-3 years of Customer Service experience
  • 0-1 year of experience working in the Healthcare Industry
Preferred Qualifications
  • 0-1 year of experience working in the Health Insurance Industry
Skills
  • Oral & Written Communication Skills
  • Telephone Skills
  • Problem Solving & Decision Making
  • Compliance
  • Healthcare Industry
  • Health Insurance
Language

English

Travel

0% - 25%

Physical, Mental Demands and Working Conditions

Office-Based

Rarely teaches/trains others

Rarely travels from the office to various work sites or from site-to-site

Never works primarily out-of-the office selling products/services

Yes, physical work site required

Lifting: up to 10 pounds

Occasionally

Lifting: 10 to 25 pounds

Rarely

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum: $19.27

Pay Range Maximum: $26.88

Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity

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For accommodation requests, please contact HR Services Online at

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Req ID: J249442

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