Remote Healthcare Customer Service Intake Call Center.
This inbound call center position serves as the initial intake of pre – service requests, claim reviews and inpatient hospital coordination and diabetic supplies. Coordinates network operations processes with Medical Directors, Network Operations Nurses, hospitals, physicians and other various departments. Provides clerical support to clinical staff in their medical necessity review process. Intake Coordinator is expected to maintain production and quality standards.
This position is full-time (40 hours/ week) with variable (varying) shifts to support our 24 hour a day, 7 days per week operations.
++Position is Remote For Candidates In Kentucky Only.++
Primary Responsibilities:
Managing authorizations / notifications and other service requests received via incoming phone calls, faxes and portal submission
Providing excellent customer service, including the ability to handle escalated callers
Determining authorization or notification requirements
Preparing authorization cases for Medical Directors, Network Operations Nurses and Case Managers
Providing administrative approvals (depends on line of business)
Handling expedited authorizations, authorization updates and status checks
Confirming member eligibility
Outreaches to providers and/or Patient to complete authorization requests and prescriptions
Maintaining knowledge of various health plan partner benefits, networks, CMS regulations and health plan partner policies
Utilizing experience and judgement to plan, accomplish goals and effectively resolve each assigned task
Non-Clinical staff is not responsible for conducting any Network Operations activity that requires interpretation of clinical information.
Performs all other related duties as assigned.
Required Qualifications:
High School Diploma / GED (or higher) – Will be required to provide documentation for verification
2+ years of combined or related experience in a healthcare adminstration with understanding of medical terminology
1+ year of call center experience
Proficiency with Microsoft Office Word (create and maintain documents), Excel (create and maintain spreadsheets) and Outlook(email and calendaring)
Should have typing speed 35+ WPM.
Ability to follow a script for every call
Required to have a dedicated work area established that is separated from other living areas and provides information privacy in compliance with HIppa regulations
Highspeed internet with 20mbps upload/download speed.
Ability to work one of the varying shift to support our 24hr 7 days a week operations
Preferred Qualifications:
Associate’s Degree (or higher) in a healthcare related field
Medical Terminology
ICD-9/ICD-10 and CPT Knowledge
Provider Inbound