Intake Specialist I

PEHP’s Intake Team plays a mission critical role in PEHP’s centralization of core operational functions by processing all inbound documents. The Intake Specialist is responsible for reviewing, approving, and processing routine forms, ensuring that data is accurately loaded into the system, and forwarding documents to other departments as appropriate. The Intake Specialist must understand PEHP forms, processes, and operation systems. Successful performance of this position requires a high-level of commitment, attention to detail, and a willingness to understand the various programs and processes within PEHP. Responsibilities Performs daily activities and functions of: Processing routine data and forms related to demographics, enrollment, prior authorization, and provider contracting when submitted electronically, including the Message Center, or by paper. Ensuring routine forms are accurate and complete before processing. Ensuring approved forms are accurately loaded into the system. When applicable, finalizes entity records loaded into the system Reviewing, indexing, and routing of documents submitted to PEHP by: Indexing files into document retention systems. Creating and finalizing entity records and initiating workflows within the PEHP core administration systems. Determining system processes and routing workflows to appropriate departments, including: Claims submissions. Appeals and payment correction requests. Recovery requests for overpayments, subrogation, and third-party liability. Returned mail. Incoming scanned mail. Documents related to enrollment, prior authorization, and provider contracting that contain data or forms that are not routine. Adheres to established guidelines and standard operating procedures to enhance efficiency and maintain compliance of internal and external service levels. Performs data processing and record finalization while verifying and ensuring accuracy of information within the system and assures timely handling of documents by: Reviewing daily, weekly, monthly, and quarterly reports on all key performance indicators. Responding to requirements, goals, priorities, and review of input data as assigned by the Intake Supervisor. Maintains regular and reliable attendance. Maintains strict confidentiality. Performs other related duties as required. Qualifications High school diploma or equivalent. PEHP experience is preferred. #J-18808-Ljbffr