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.
- 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