Job Title: Intake Care Senior Representative (100% REMOTE)
Duration: 4 Months
Schedule Notes:

• M-F, Shifts will land between 7:30AM-7:30PM CST
• 8 Hour shifts with 30 min lunch
• Training will be the first 4 weeks

 
Note:

• This position is 100% remote and candidates can be sourced from across the US as long as they're able to support the CST schedule.
• Candidates submitted cannot have any time off during the first 5 weeks - do not submit candidates that have pre-planned time off during this timeframe.
• Candidates must have a quiet and private working environment.
• Candidates must have a reliable, high-speed internet connection.
• Candidates must have a hard-wired internet connection to connect into the equipment - WiFi connection will not suffice.

 
Position Summary:
The Pre-Certification Specialist is responsible for supporting the Precertification Nurse, Medical Director and Director of Health Services by collecting, interpreting and evaluating medical information received for authorization. The Pre-cert Specialist will communicate with internal and external providers regarding authorization status. This position is for a phone queue representative.
 
Essential Duties and Responsibilities:

• Receive request for authorization from hospitals, providers, customers and vendors via fax, phone and portal.

• Meet service level goals (e.g., Grade of Service, Average Handle Time, Average Speed to Answer, abandonment rate)
• Determine authorization requirements based on company policy, member benefit grid and provider status.
• Review customer coverage and benefits
• Review authorization requests and make determinations on correct authorization process (i.e. auto approve, refer to Utilization Management Nurse)
• Maintain benchmark standards for TAT (Turn-Around-Time) as established by the organization.
• Professional demeanor and the ability to work effectively within a team or independently
• Flexible with the ability to shift priorities when required
• Maintains regular and acceptable attendance in accordance with Time Away From Work policy
• Ability to work evening, weekend and holiday shifts to support the UM Department
• Other duties as requested

 
Skills/Requirements:

• Proficient in medical terminology, CPT, HCPCS and ICD-10 coding
• Effective oral and written communication skills
• Strong customer orientation
• Substantial knowledge of Microsoft Office including Outlook, PowerPoint, Excel and Word
• Excellent typing skills
• Previous call center/phone queue experience required

 
Knowledge, Skills, Abilities Required:

• Excellent interpersonal and communications skills with nursing staff, physicians, nurse practitioners and other health workers involved in the care of a customer
• Ability to meet deadlines and manage multiple priorities, and effectively adapt and respond to complex, fast-paced, rapidly growing, and results-oriented environment
• Proficient knowledge of departmental policies and procedures
• Knowledge of Medicare Regulatory Requirements
• Previous experience working in a remote environment

 
Education:

• High School Diploma and preferred 1-2 years’ experience in a managed care environment