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.



•        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



·         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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