Job Description

Job Description:

 

·         Principal Accountabilities:

•        Screens information received and refers members to the appropriate provider and/or contacts the provider directly for members.

•        Facilitates the authorization process for requests that do not require clinical criteria application or judgment.

•        Provides relevant information to members and assists them in resolving Plan related problems when Member Services personnel are not available.

•        Acts as a resource to staff for questions related to the prior authorization process.

•        Refers unresolved prior authorization process questions to the Lead Intake Specialist.

•        Assists the Lead Intake Specialist in identifying, planning and implementing staff training programs.

•        Identifies and reports member and provider educational opportunities to the Lead Intake Specialist.

•        Accurately answers questions regarding Plan benefits and Utilization Management requirements for members and providers.

•        Makes appropriate inquiries to determine potential coordination of benefits and advises appropriate provider and claims staff of same.

•        Supports Utilization Management nurses with data entry.

•        Performs other duties as assigned.

•        Adheres to Select Health and KMHP policies and procedures.

•        Supports and carries out the Select Health and Mercy Mission & Values.

 

Skills:

•        Customer service experience and interpersonal skills on phone and in-person

•        Proficient PC Skills in a Windows based environment including word processing, spread sheets and working in database programs.

•        Working knowledge of plan benefits and services

•        Proven ability to keep accurate and timely records and documentation according to established processes

 

Education:

·         High School Diploma / GED

·          

 

 

Company Description

Della Infotech Inc is in staffing business for five years. Over the years, we have placed hundreds of candidates to various temp and permanent positions with our 50+ happy clients all over US and Canada including Fortune 500 corporations.

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