Primary Responsibilities

• Positions in this function includes those responsible for initial triage of members, administrative intake of members or managing the admission/discharge information post-notification, working with hospitals and the clinical team
• Includes managing incoming calls, managing requests for services from providers/members, providing information on available network services and transferring members as appropriate to clinical staff
• Extensive work experience within own function
• Work is frequently completed without established procedures
• Works independently
• Act as a Subject Matter Expert for other team members
• Manage the intake of members or the admission/discharge information post notification
• Work with hospitals, clinics, facilities and the clinical team to manage requests for services
• Manage the referral process, processing incoming and outgoing referrals and prior authorizations, including intake, notification and census roles
• Resolve inquiries from members and/or providers
• Part of the challenge here is dealing positively with members and providers in sometimes challenging circumstances
• As a subject matter expert, you'll also be the "go-to" resource for information
• The flexibility to work evening hours will also be required

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

• HS Diploma or GED
• 2 years experience analyzing and solving customer problems
• 2 years of experience working in the health care industry
• 2years of experience working with medical terminology

Preferred Qualifications

• Experience working with health care insurance
• Experience in a hospital, physician's office or medical clinic setting
• Clerical or administrative support background or experience working in a call center environment
• Experience working with Medicare and/or Medicaid Services