Customer Service Representative

Job Description :

Assists Care Managers to open, document, and monitor utilization and care management cases and work designated reports. Provides superior customer service to all inquiries and questions regarding Care Management and Preauthorization for members, providers, facilities, vendors and other departments and teams.

Job Essentials

Participates in utilization management, care management and disease management programs by starting cases, routing cases to the Care / Disease Manager per the Trigger List and completing cases per department processes.

Supports care managers by being a resource for system related issues. Contacts facilities, physician offices, and other parties as directed by the Care / Disease Manager. Identifies eligible members for the various programs, making initial phone calls, referring members to Care / Disease Managers as appropriate, and providing appropriate educational materials as requested. Documents all activities in the designated system.

Receives incoming calls from members, providers, facilities, vendors, and other departments while providing professional solutions and information for situations and problems. Follows established guidelines to complete preauthorizations for members and providers.

Makes outbound calls as needed to gather information for compliance with NCQA guidelines or preauthorization completion.

Works cases in a timely manner as per next review date and department processes. Performs case reviews of requested services in a timely manner as documented in preauthorization standards. Notifies requesting providers of review outcome.

Completes report assignments in designated time frames. Reviews inpatient facility census, monitors and documents facility costs, and makes referrals to Care / Disease manager as appropriate.

Ensures work is completed in compliance with NCQA. Follows department processes to meet all NCQA accreditation standards related to the Intake Coordinator position. Provides accurate and timely information for preauthorizations that require benefit determinations.

Complies with established auditing criteria for calls and preauthorizations. Stays current and conversant on customer service call audit criteria as well as preauthorization and care management guidelines to provide accurate information and NCQA compliant service.

Maintains customer history within preauthorization notes when applies and member tracking when a preauthorization is not required using correct codes and detailed comments.

Minimum Qualifications

Two years of medical office / insurance, or health related customer service experience; experience must include taking incoming or making outgoing telephone calls in a professional environment.

• and -

Demonstrated beginner computer skills in word processing.

Preferred Qualifications

Knowledge of medical terminology or medical background, and be confident in learning new systems and databases.

Effective time management skills, and excellent verbal communication skills.

Excellent problem solving and reasoning skills in a team environment.

Self-starter, with attention to detail, requiring minimal supervision.

Professional, enthusiastic, and able to work well under pressure.

Physical Requirements :

Manual dexterity, hearing, seeing, speaking.

Location :

Nevada Central Office

Work City : Las Vegas

Work State : Nevada

Scheduled Weekly Hours :

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

18.38 - $26.65

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits package here () .

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

All positions subject to close without notice.

Salary : $18 - $27