Intake Coordinator

Highmark Inc. Job Posting

Job Summary : This job captures all inbound inquiries for utilization management review from providers and pharmacies. The incumbent assesses the request, conducts all necessary research such as verifying benefit coverage for the member, and then creates the case (data entry) in Highmark's Utilization Management system for Prior Authorization 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, Predictal Availity portal and / or service form inquiry. At times may require follow-up communication with the requestor's office (physicians or pharmacists). This role may be required to make outbound calls and / or triage cases if inventory levels require support.

Essential Responsibilities :

• Obtain requests from provider or pharmacy via fax, provider portal or service form inquiry. May obtain requests from provider or pharmacy by phone in some areas of the organization. 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, outreach to providers and / or pharmacists may be required to obtain additional information.
• Ensure accuracy of data entry to prevent compliance and / or downstream process issues.
• Other duties as assigned or requested.

Experience :

Skills :

Education :

Licenses or Certifications :

Language (Other than English) : None

Travel Requirement : 0% - 25%

Physical, Mental Demands and Working Conditions :

Pay Range Minimum : $19.27

Pay Range Maximum : $26.88

Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. 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 any category protected by applicable federal, state, or local law.

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