Senior Intake Coordinator

Highmark Inc. Job Posting

This job captures all inbound phone inquiries for utilization management review from providers and pharmacies. The incumbent assesses the verbal request, critically thinks through the inquirer's concerns which may require research to fulfill the call, such as verifying benefit coverage, creation of a prior authorization case in Highmark's Utilization Management system for Prior Authorization clinical review, status research, etc. Ensures all accurate information is verified and entered at the onset of the process to ensure adherence to all regulatory compliance requirements and service level agreements. This role may be required to make outbound calls, triage cases, and / or build cases if inventory levels require support.

Essential Responsibilities :

• Handle all inbound phone requests from providers or pharmacy for all inbound Prior Authorization requests. Use multiple software systems and various resource sites to determine member plans and requirements while gathering all appropriate documentation including verification of benefit eligibility. Ensure conversation highlights are captured within the system. If required, build cases in the utilization management system.
• Utilize critical thinking to ensure call is being appropriately responded to while gathering all required documentation. Appropriately evaluate call and determine if de-escalation is required.
• Ensure accuracy of data entry to prevent compliance and / or downstream process issues.
• Other duties as assigned or requested

Education :

Experience :

Licenses and Certification :

Skills :

Language (Other than English) : None

Travel Required : 0% - 25%

Physical, Mental Demands and Working Conditions :

Pay Range Minimum : $20.31

Pay Range Maximum : $29.53

Base 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.

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