What are the responsibilities and job description for the Intake Care Senior Representative position at Hire Talent?
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
Qualifications :
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
