Intake Coordinator

Job ID: J142547
Company: Highmark Inc
Location: Charleston, WV, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Mar 11, 2019

Share:

Description

General Overview:

This job captures all inbound requests for utilization review from providers and pharmacies.  The incumbent assesses the request, conducts all necessary research such as verifying benefit coverage for the patient, and then creates the case (data entry) in Highmark's utilization management system for 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 or phone, and at times may require follow-up calls with physicians or pharmacists.  

Essential Job Functions:

  • Obtain requests from provider or pharmacy via phone, fax, or provider portal (online).   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, contact by phone members, providers and/or pharmacists to obtain additional information.  
  • Ensure accuracy of data entry to prevent compliance and/or downstream process issues.
  • Other duties as assigned.

Minimum Qualifications:

  • High School Diploma/GED
  • 1 - 3 years of Customer Service experience
  • 0 - 1 year of experience working in the Healthcare Industry

Preferred Qualifications:

  • 0 - 1 year of experience working in the Health Insurance Industry

Referral Bonus: Level 1

Disclaimer: The 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 position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

    Summary

    This job captures all inbound requests for utilization review from providers and pharmacies.  The incumbent assesses the request, conducts all necessary research such as verifying benefit coverage for the patient, and then creates the case (data entry) in Highmark's utilization management system for 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 or phone, and at times may require follow-up calls with physicians or pharmacists. 

    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 their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
    EEO is The Law
    Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
    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 number below.
    For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

    Share:

    Interested in working at the Highmark Health enterprise?
    Take the first step by joining our Talent Network today!

    Join Our Talent Network

    Similar Jobs

    Manager Clinical Care Coordination

    Wilmington, DE, United States
    Clinical Services

    Clinical Care Coordinator - Utlization Management

    Home, DE, United States
    Clinical Services

    Intake Coordinator (Pharmacy Frontline)

    Pittsburgh, PA, United States
    Clinical Services

    Intake Coordinator (Pharmacy Frontline)

    Wilkes-Barre, PA, United States
    Clinical Services

    Supervisor - Intake Coordinator

    Charleston, WV, United States
    Clinical Services

    Change Execution Analyst

    Home, PA, United States
    Clinical Services

    Director Clinical Operations

    Wilmington, DE, United States
    Clinical Services

    Supervisor Utilization Management

    Home, DE, United States
    Clinical Services

    Enhanced Community Care Manager, RN

    Washington, PA, United States
    Clinical Services

    Supervisor Case Management

    Home, DE, United States
    Clinical Services

    Manager Clinical Care Coordination - UM Behavioral Health

    Wilmington, DE, United States
    Clinical Services

    Intake Coordinator

    Charleston, WV, United States
    Clinical Services

    LTSS Case Manager

    Home, DE, United States
    Clinical Services

    Clinical Client Integration Manager

    Wilkes-Barre, PA, United States
    Clinical Services

    Behavioral Health Specialist

    Home, PA, United States
    Clinical Services

    Behavioral Health Specialist

    Pittsburgh, PA, United States
    Clinical Services

    Behavioral Health Specialist

    Pittsburgh, PA, United States
    Clinical Services

    Behavioral Health Specialist

    Home, PA, United States
    Clinical Services

    Enhanced Community Care Manager

    Greensburg, PA, United States
    Clinical Services

    Social Worker (Erie territory)

    Erie, PA, United States
    Clinical Services

    Social Worker (Erie territory)

    Home, PA, United States
    Clinical Services

    Director Clinical Services High Costs

    Pittsburgh, PA, United States
    Clinical Services

    Clinical Educator - Post Acute

    Pittsburgh, PA, United States
    Clinical Services

    Pediatric Clinical Care Coordinator

    Wilmington, DE, United States
    Clinical Services

    Child Grief Specialist/Volunteer Services Coordinator

    Lemoyne, PA, United States
    Clinical Services