This high volume, customer service environment. You'll need to be efficient, productive and thorough dealing with our providers and members over the phone and managing fax. You also must be able to work a flexible schedule that includes evening hours and rotating weekends.
This position is responsible for the daily coordination of the administrative intake of members in the Intake Call Center. This is high volume, customer service environment. You'll need to be efficient, productive and thorough dealing with our providers and members over the phone. You also must be able to work a flexible schedule that includes evening hours.
- Process incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles
- Work with hospitals, clinics, facilities and the clinical team to manage requests for services from members and/or providers
- Assist the clinical staff with setting up documents/triage cases for Clinical Coverage Review
- Provide excellent customer service, including the ability to handle escalated callers
- Handle resolution/inquiries from members and/or providers
- Provide administrative approvals (depends on line of business)Handling expedited authorizations, authorization updates and status checks
- Responsible for outreaches to providers and/or Patient to complete authorization requests and prescriptions
- Maintain knowledge of various health plan partner benefits, networks, CMS regulations and health plan partner policies
- Perform all other related duties as assigned
This is a call center environment near Lockhill Selma Rd. / De Zavala / IH - 10 / Loop 1604, San Antonio, TX, 78249, Mon - Fri: 7AM - 6PM (11HRS) / Required Rotating Sat - Sun: 8AM - 5PM.