What are the responsibilities and job description for the Pipeline-Intake Care Senior Representative position at Mindlance?
Responsibilities :
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 :
Knowledge, Skills, Abilities Required :
Education :
Please let me know if you have any questions.
EEO :
Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority / Gender / Disability / Religion / LGBTQI / Age / Veterans."
