Senior Intake Management Specialist

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

We are seeking a dedicated Senior Intake Management Specialist to handle inbound inquiries related to utilization management from providers and pharmacies. In this role, you will assess verbal requests and critically analyze the inquirer's concerns, which may involve conducting research to provide accurate assistance, such as verifying benefit coverage and initiating prior authorization cases in Highmark's Utilization Management system. You will ensure compliance with all regulatory requirements and service level agreements by accurately documenting information from the outset of the process. This position may require making outbound calls, triaging cases, and supporting case management as inventory levels demand.

ESSENTIAL RESPONSIBILITIES

Manage all inbound phone inquiries from providers and pharmacies for Prior Authorization requests. Utilize multiple software systems and resources to verify benefits and eligibility and gather essential documentation. Ensure key conversation notes are accurately recorded within the system and build cases in the utilization management system as necessary.

Employ critical thinking to effectively respond to inquiries, ensuring all required documentation is collected and evaluated for de-escalation when necessary.

Ensure precision in data entry to avoid compliance issues and streamline downstream processes.

Perform additional duties as assigned or required.

EDUCATION

Required

High School Diploma/GED

EXPERIENCE

Required

Minimum of 3 years in customer service.

At least 1 year in the healthcare industry.

SKILLS

Excellent written and oral communication skills.

Proficient in navigating various software systems simultaneously.

Strong knowledge of administrative procedures and systems, including word processing and file management.

Aptitude for effective interaction with peers, supervisors, and customers.

Exceptional problem-solving abilities.

Understanding of customer service principles and processes.

TRAVEL REQUIRED

0% - 25%

PHYSICAL AND MENTAL DEMANDS & WORKING CONDITIONS

This position is office-based, with occasional requirements to lift up to 10 pounds. It involves primarily office work, and you may be tasked with teaching or training others regularly.

Please Note: This job description outlines the general duties and responsibilities of the role but is not exhaustive. It is essential to comply with all legal and ethical standards as established by company policies and applicable regulations, including HIPAA.

Pay Range: $20.31 - $30.12

Highmark Health is committed to equal employment opportunities for all qualified individuals without discrimination based on veteran status or disability and ensures adherence to federal, state, and local laws.

If you need assistance or accommodation with the application process, please contact HR Services Online.

Req ID: J269786