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Intake Care Senior Representative

  • Location

    Hoover, United States

  • Sector:

    Other Area(s)

  • Job type:

    Contract

  • Contact:

    Leric Arcigal

  • Job ref:

    22728

  • Published:

    9 months ago

  • Expiry date:

    2021-01-13

Receives request for authorization from hospitals, providers, members and vendors. Maintain benchmark standards for TAT (Turnaround Time) as established by the organization.

Determine authorization requirements based on company policy (PPAL/IPAL), member benefit grid and provider status.

Review authorization requests and make determinations on correct authorization process (i.e. auto approve, refer to Precert Nurse or Medical Director).

May perform research to respond to inquiries and interprets policy provisions to determine most effective response.

Collaborates on responses to inquiries, grievances, complaints or appeals ranging from routine to moderate complexity.

Determine authorization requirements based on company policy, member benefit grid and provider status.

Review authorization requests and make determinations on correct authorization process (i.e. auto approve, refer to Precert Nurse or Medical Director).

Provide determinations on authorizations request to members and/or providers based on benchmark standards for authorization decisions. Process extensions, Retro or Expedited authorizations as appropriate. Completes review of non-authorized medical claims Proficient knowledge of departmental policies and procedures; knowledge of Medicare, HIPAA and NCQA ; 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 employers sole discretion Other duties as requested