Intake Coordinator

Job TitleUtilization Management ReviewerJob DescriptionThis job captures all inbound inquiries for utilization management review from providers and pharmacies. The incumbent assesses the request, conducts all necessary research such as verifying benefit coverage for the member, and then creates the case (data entry) in Highmark's Utilization Management system for Prior Authorization clinical review. Ensures all accurate information is entered at the onset of the process to ensure adherence to all regulatory compliance requirements and service level agreements. The requests may come via fax, Predictal Availity portal and/or service form inquiry. At times may require follow-up communication with the requestor's office (physicians or pharmacists). This role may be required to make outbound calls and/or triage cases if inventory levels require support.Essential ResponsibilitiesObtain requests from provider or pharmacy via fax, provider portal or service form inquiry. May obtain requests from provider or pharmacy by phone in some areas of the organization. Use multiple software systems and various resource sites to determine member plans and requirements. Gather all required documentation including verification of benefit eligibility. Build cases in the utilization management system.Use knowledge of process and judgement to evaluate identified cases that require additional notification to member, provider, and/or pharmacist. At times, outreach to providers and/or pharmacists may be required to obtain additional information.Ensure accuracy of data entry to prevent compliance and/or downstream process issues.Other duties as assigned or requested.ExperienceRequired1 year of Customer Service experience1 year of Healthcare IndustrySkillsPossess good written and oral telephonic communication skillsAbility to navigate through multiple systems simultaneouslyKnowledge of administrative and clerical procedures and systems such as word processing, managing files and digital faxAbility to interact well with peers, supervisors, and customersProblem-SolvingKnowledge of principles and processes for providing customer service. This includes customer needs assessment, meeting quality standards for services.EducationRequiredHigh School/GEDLicenses or CertificationsRequiredNoneLanguage (Other than English):NoneTravel Requirement:0% - 25%Physical, Mental Demands and Working ConditionsPosition TypeOffice- or Remote-basedTeaches / trains othersOccasionallyTravel from the office to various work sites or from site-to-siteRarelyWorks primarily out-of-the office selling products/services (sales employees)NeverPhysical work site requiredNoLifting: up to 10 poundsConstantlyLifting: 10 to 25 poundsOccasionallyLifting: 25 to 50 poundsRarelyCompliance RequirementThe job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.Pay RangePay Range Minimum: $19.66Pay Range Maximum: $27.42Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.For accommodation requests, please contact HR Services Online at View email address on click.appcast.io Consumer Privacy Act Employees, Contractors, and Applicants Notice