Intake Specialist II

Job not on LinkedIn

🔥 5 minutes ago

🏈 Ohio – Remote

🏈 Ohio – Remote

💵 $41.2k - $66k / year

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

📋 Description

• Convert information received from providers/members via fax, phone, provider portal, or mail into electronic records while verifying member eligibility, provider network status, and benefit coverage • Review requests and send fax back for ineligible members, duplicate requests, and items not covered by medical benefit • Facilitate authorization of benefits for participating and out-of-network providers, including completing appropriate forms and generating approval letters • Place prior authorizations when approval is appropriate per SOP into medical management systems • Initiate routing of prior authorizations requiring medical necessity review by clinical care reviewer • Communicate with providers regarding prior authorization requests and troubleshoot provider issues • Provide authorization information to providers, facilities, and/or members • Assist the Clinical team to ensure requests requiring clinical review are received and processed timely • Monitor workload aging and respond with appropriate urgency • Meet department standards and goals • Collaborate across company departments on issues, overrides, and questions • Maintain knowledge of processes and procedures for multiple markets • Cross-train in multiple markets and products • Adhere to departmental and company policies and procedures • Perform other job-related instructions as requested

🎯 Requirements

• High School Diploma or equivalent required • Minimum of eighteen (18) months of clinical and/or insurance experience, or related healthcare education or certification (i.e. STNA, MA, etc.) is required • Managed care experience preferred • Computer proficiency with knowledge and experience with Microsoft Office in a Windows based environment • Ability to analyze information • Ability to work independently and within a team environment • Attention to detail • Proper grammar usage • Critical listening and thinking skills • Professional phone etiquette • Customer service oriented • Decision making/problem solving • Change resiliency • Knowledge of behavioral health systems • Ability to accurately communicate summary information in a written format • Medical Terminology Certificate is preferred • Flexibility to work weekends and/or holidays, as needed

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Substantial and comprehensive total rewards package • Remote work arrangement • Flexibility to work weekends and/or holidays as needed

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