Intake Specialist

Job Title: Intake Specialist
Type: Contract
Contractor Work Model: Remote – offsite

Hours: 11:00 a.m. to 7:30-8:00 p.m EST (depending on 30 or 60 minute lunch break)

Responsibilities

• Handle incoming calls from providers, assisting with reviewing authorization details, requirements, or updates.
• Convert information obtained from providers/members into electronic records, verifying member eligibility, provider network status, and benefit coverage.
• Review requests and communicate ineligible members, duplicate requests, or non-covered items back to providers via fax.
• Facilitate authorization of benefits for participating and out-of-network providers, including completing necessary forms and generating approval letters.
• Place prior authorizations when approval is obtained per SOP in the medical management systems.
• Initiate routing of prior authorizations requiring medical necessity review by clinical care reviewers.
• Respond to provider inquiries regarding prior authorization requests and troubleshoot issues.
• Ensure all inquiries via fax, e-mail, phone, and provider portal are addressed within mandated timeframes.
• Cross-train interdepartmentally for all Medicaid and Marketplace products.
• Collaborate across department teams to resolve issues, overrides, and questions.
• Facilitate inbound and outbound contact with providers to obtain additional information for UM processes.
• Provide authorization information to providers, facilities, and/or members.
• Assist Clinical team to ensure timely processing of requests requiring clinical review.
• Maintain awareness of workload aging and respond appropriately to meet department standards and goals.
• Adhere to departmental and company policies and procedures.
• Perform any other job-related instructions as requested.

Requirements

• High School Diploma or equivalent required.
• Minimum of one (1) year of clinical, insurance, or related healthcare experience preferred.
• Managed care experience preferred.
• Proficiency with Microsoft Office in a Windows environment.
• Strong analysis, communication, and problem-solving skills.
• Ability to work independently and as part of a team.
• Attention to detail, proper grammar, and professional phone etiquette.
• Critical thinking, decision making, and change resiliency skills.
• Knowledge of behavioral health systems is a plus.
• Medical Terminology Certificate is preferred.

System One, and its subsidiaries including Joulé and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.

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Ref: #861-Cincinnati-S1