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Corporate Functions & Operations WellCare - Clinical Support Careers

Intake Operations Coordinator - Senior Job

Full Job Title: *Intake Operations Coordinator, Sr

Job Number: 1802908

Location: Phoenix, AZ

Date Posted: 5-25-2018

This position is for Care1st Health Plan, a WellCare Healthplans, Inc. company.

Department:Health Services -Medicaid

Reports to: Operations Supervisor

Location: E. Camelback Rd, Phoenix AZ 85016

Job Type: Hourly/ Non-exempt

Processes phone and fax authorization requests for behavioral health services received from physicians and hospitals ("providers") in an efficient, accurate and customer-focused manner. Serves as a resource adviser for customer issues such as pending authorizations, corrections to initial authorizations, escalated calls from providers and assists with ongoing education of providers regarding protocol. Regularly answers questions for intake coordinators. Assists with reporting as assigned.

Essential Functions:

  • Effectively handles authorization requests via phone or fax from providers, balancing excellent customer service with efficiency
  • Follows appropriate procedures for checking member eligibility, authorization history and provider network participation status
  • Based on the information provided by the provider and gathered from computer systems, determines the appropriate handling of each inpatient or outpatient request
  • Utilizes on line tools to determine authorization requirements based on the type of service requested, the location of the service and the provider specifics
  • Accurately enters authorization requests into WellCare's system
  • Based on the authorization rules and urgency of the request, either approves the authorization request or escalates to a nurse for review
  • Communicates authorization specifics to providers either verbally on phone calls or written through fax
  • Evaluates and prioritizes incoming provider's requests via phone/fax and/or from other Coordinators
  • Handles problem recognition. Researches and engages the assistance of other departments to help in resolving complex problems
  • Coordinates provider service authorizations of escalated nature for immediate resolution
  • Assists and provides support to coworkers regarding process flow, job and product knowledge in accordance with ongoing training initiatives
  • Completes review of routine reports for Supervisor/Manager (as defined & scheduled by Supervisor/Manager). Works individually with peers as issues are identified, assesses for department trends and takes action accordingly to troubleshoot (working with department Supervisor/Manager & Trainer)
  • Performs other duties as assigned.
Candidate Education:
  • Required A High School or GED
Candidate Experience:
  • Required 6 months of experience in entry level Intake Coordinator position (pending previous outside experience and current performance)
  • Preferred 1 year of experience in entry level Intake Coordinator position (pending previous outside experience and current performance)
  • Preferred Other call center experience
Candidate Skills:
  • Intermediate Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
  • Intermediate Demonstrated interpersonal/verbal communication skills

Technical Skills:
  • Preferred Intermediate EMMA
  • Required Intermediate Microsoft Outlook
  • Required Beginner Microsoft Excel
  • Required Beginner Microsoft Word
  • Required Intermediate Other Ability to manage multiple computer programs to process a single request
  • Required Intermediate Other Proficient in data entry

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Last Updated On: 12/9/2015