Intake Coordinator
2 weeks ago
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.
- High School Diploma/GED
- 1-3 years of Customer Service experience
- 0-1 year of experience working in the Healthcare Industry
- 0-1 year of experience working in the Health Insurance Industry
- Oral & Written Communication Skills
- Telephone Skills
- Problem Solving & Decision Making
- Compliance
- Healthcare Industry
- Health Insurance
English
Travel0% - 25%
Work EnvironmentOffice-Based
This position requires regular interaction with healthcare professionals and patients, and may require occasional travel to various work sites.
Highmark Health is an equal opportunity employer and prohibits discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibits 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.
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