Intake Coordinator I

Responds to provider requests telephonically and electronically for preauthorization of inpatient admissions and outpatient services and procedures. Verification of benefits, eligibility and provider network status. Promotes and maintains a positive company image through telephonic and electronic contact with internal and external customers.

• This role does not manage people
• This role reports to this job: SUPERVISOR, CLINICAL INQUIRY
• Necessary Contacts: All levels of BCBSLA personnel, providers, and subscribers; including Special Accounts, Member Service, Provider Service, Benefits Administration, Network Administration, Utilization Review Nursing Staff, Medical Directors, Medical Necessity Appeals, Administrative Appeals, Pharmacy and Providers staff.

• High School Diploma or GED required
• Some college course work preferred

• 1 year call center experience or prior knowledge of a health insurance pre-service authorization required

• Excellent listening, reading, comprehension, oral and written communication skills required
• Effective organizational and interpersonal skills required
• Ability to multi-task and handle work independently as well as prioritize multiple customer issues required
• Working knowledge of relevant PC software (Microsoft Word and Excel) required
• Working knowledge of medical terminology required
• Must be able to verbally communicate on the telephone in a call center environment, approximately 95% of the time.
• Ability to sit at a desk and answer calls for prolonged periods of time with pre-determined breaks required
• Facets experience preferred

• None Required

• Responds to provider requests telephonically and electronically for preauthorization of inpatient admissions and outpatient services and procedures. Verifies benefits, eligibility and provider network status. Responsible for meeting targets for staff and unit performance as required by company and management standards to ensure achievement of departmental productivity goals
• Receives member clinical data, enters relevant case information and follows departmental processes to authorize services as appropriate. If processes do not allow approval, forwards cases and attached clinical data to the appropriate Utilization Review team. Ensures authorizations are conducted in a manner that minimizes any disruption in the provision of healthcare, standardizes the timeliness of the decisions and maintains flexibility to accommodate providers’/members’ needs to help ensure customer satisfaction
• Responsible for timely management of appropriate verbal notifications and/or written materials to ensure compliance with regulatory and/or operational guidelines
• Maintains thorough knowledge of required lines of business, changes to recent laws and regulations, standard data exchange code sets, medical terminology, computer systems and Care management and URAC policies and procedures to ensure consistency in delivery of excellent customer service and accreditation compliance
• Accountable for special assignments/projects as requested by management
• Accountable for complying with all laws and regulations associated with duties and responsibilities

• Perform other job-related duties as assigned, within your scope of responsibilities.
• Job duties are performed in a normal and clean office environment with normal noise levels.
• Work is predominately done while standing or sitting.
• The ability to comprehend, document, calculate, visualize, and analyze are required.