Ops Intake Coordinator

Receives inbound calls from providers to determine authorization requirements, answer general questions and/or submit authorization requests for services rendered. Receives faxed authorization requests and performs data entry functions to submit requests for review. Complies with organizational policies and procedures, regulatory requirements, and other established criteria and guidelines. Maintains confidentiality of business and protected health information. Performs other data entry, administrative support, reporting and other related tasks, as-needed.

Essential Functions:
  • Answers telephones according to established grade of service standards
  • Collects and verifies information concerning member eligibility, provider status, authorization requirements and authorization status
  • Provides customer service functions to help coordinate member needs
  • Performs data entry of authorizations in the electronic medical management system
  • Conducts outbound calls to follow up on inquiries related to the member and/or authorization process as-needed
  • Assists in preparing and submitting projects, reports or assignments as-needed to meet organizational initiatives and/or objectives
  • Adheres to standard metrics for quality, production and average call handling time
  • Communicates authorization specific to providers either verbally on the phone calls or written through fax
  • Performs other duties as assigned.
Additional Responsibilities:
    Candidate Education:
    • Required A High School or GED
    Candidate Experience:
    • Required 1 year of experience in customer service experience
    • Preferred Other Call Center experience
    Candidate Skills:
    • Beginner Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
    • Intermediate Ability to work as part of a team
    • Intermediate Ability to work in a fast paced environment with changing priorities
    • Intermediate Other Type 40 wpm
    Licenses and Certifications:
    A license in one of the following is required:
      Technical Skills:
      • Preferred Beginner EMMA
      • Required Intermediate Microsoft Word
      • Preferred Intermediate Microsoft Outlook
      • Preferred Beginner Microsoft Excel
      • Preferred Beginner SharePoint

        About us
        Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.