Primarily responsible for processing initial incoming faxes or phone requests into the intake department Gathering
demographic and benefit data and documenting in appropriate system. This is determined through documented policy and
procedures.
• Adheres to time frames, and turn around times, as evidenced by results of inter-rater reliability reviews.
• Routes and evaluates all calls and faxes to refer and assign as necessary to other staff.
• Performs data entry of authorization information into systems, and or fax information to, originating physician and or
facility or specialist.
• Implements nuances of product line and regulatory requirements in the processing of all authorization requests including
notification requirements.
• Responsible for confirming eligibility for requested authorizations and for requesting membership identification numbers
for newborns.
• Utilizes resources available from TCHP or State Agencies. Reference may be made by phone or online. Dates must be
referenced prior to authorizations.
• Assists with complaint and appeal process regarding eligibility/claims and documents appropriately in the UM system.
REQUIREMENTS:
• Managed care, preferably in medical management department, claims and member service background helpful. Health
care setting employment a plus.
• Ability to operate PC, Windows, Word, fax machine, photocopier, computer and multi line telephone.
• Excellent customer service skills and phone etiquette are required.
• Ability to handle high volume of calls, prioritize work, be flexible and perform as member of a team is required.
• ICD and CPT coding skills (preferred)
Previous health plan experience is preferred.
No certifications are required.
Typing and Data Entry is required.
Medical Terminology (ICD–10 & CPT coding),
Place of service knowledge is required)
Customer Service experience preferred.
Day shift 8:00 am to 5pm or 8:30 to 5:30pm or 9:00 to 6:00pm