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Intake Care Senior Representative (TN)
Ref No.: 20-01764
Location: Nashville, Tennessee
Intake Care Senior Representative
Location: Nashville, TN
Hours: Work From Home, Shifts are between 8-8 CST Mon to Fri, Rotating weekends
Pay: $21.59
Start: 4/1/2020

Duties:

The Intake Care Senior Representative is responsible for accepting pre-certification requests from physicians and members and processing in accordance with CMS guidelines. The Intake Care Senior Representative will communicate with internal and external providers regarding authorization status.

Essential Duties and Responsibilities:
  • Receive request for authorization from providers and members; Meet service level goals (e.g., Grade of Service, Average Handle Time, Average Speed to Answer, abandonment rate)
  • Determine authorization requirements based on company policy, member benefit grid and provider status.
  • Enter authorization requests and route to Part B Clinical Reviewer for decision.
  • Maintain benchmark standards for TAT (Turn around Time) as established by the organization.
  • Provide outcomes on authorization requests to members and/or providers based on benchmark standards for authorization decisions.
  • Processes denials including correspondence sent to families, members, facilities and applicable contracted providers.
  • Entering authorizations into the claims system and testing claims for proper co-pay costs.
  • Notifies responsible parties prior to initiation of denial letter and ensures that member and responsible party understand details of the letter and the appeals processes to follow.
  • Professional demeanor and the ability to work effectively within a team or independently.
  • Flexible with the ability to shift priorities when required.
  • Maintains regular and acceptable attendance at such level as is determined at the employer’s sole discretion.

Skills:
  • Excellent interpersonal and communications skills with nursing staff, physicians, nurse practitioners and other health workers involved in the care of a member
  • Able to work in a dynamic, fast-paced team environment and to promote team concepts.
  • Availability to work weekends and holidays including evening hours.
Computer Skills:
  • Substantial knowledge of Microsoft Office including SharePoint, Outlook, PowerPoint, Excel and Word.
Education:
  • High School Diploma and 3-4 years’ experience in a managed care environment.
  • Must be proficient in medical terminology, CPT and ICD-9/ICD-10 coding.
  • Knowledge of Medicare and HIPPA.
  • Appropriate Pharmacy Technician certifications/licensing as required by the state of residence or the ability to obtain within 1 year of position start date.
  • Certified Bilingual English/Spanish preferred.
Languages:
English Read Write Speak
Spanish Read Write Speak