Overview
Responsibilities
Qualifications
Completes data input for authorization/service requests. Works collaboratively with other departments to troubleshoot and resolve authorization related issues in a timely and efficient manner. Ensures timely and effective delivery of services. Works under general supervision.
Responsibilities
- Creates and modifies authorizations and/or orders for new and existing Members in an accurate and timely matter
- Researches, troubleshoots, resolves authorization and/or order processing issues and discrepancies
- Completes activities, including but not limited to, inbound/outbound calls, as assigned, faxes and emails
- Obtains information from internal and external sources. Processes or triages the request via our medical management information system or external sources
- Coordinates with Providers and Members regarding authorization requests and/or activities
- Communicates with Care Management, Member Services, Membership and Eligibility and other internal departments regarding Member services, authorization requests and issues
- Reviews all authorization requests for accuracy and prioritizing based on urgency
- Documents communication, actions taken and barriers in the Medical Management System as it pertains to the Members Care or request for services
- Utilizes internal and external systems to verify eligibility and Provider Information such as name, address, fax number, NPI and TAX ID.
- Conducts follow-up, as necessary, to ensure member satisfaction and successful delivery of service
- Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
- Performs other duties and special projects, as assigned
Qualifications
Education: High School degree or equivalent required.
Experience: Minimum of two years of experience in a customer service role required. Excellent oral and written communication skills required. Advanced personal computer skills, including Word, Excel or Access required. Utilization Management experience preferred.
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