Offer summary

Qualifications:

Minimum of 2 years of experience in healthcare or insurance fields., High school diploma with college experience preferred., Knowledge of medical terminology and health insurance processes is required., Strong communication skills and customer service experience are essential..

Key responsabilities:

Handle inbound and outbound calls related to medical management and prior authorization.

Process provider requests and manage documentation in Care Advance.

Collaborate with cross-functional teams to ensure quality service delivery.

Maintain positive relationships with clients and stakeholders while addressing compliance inquiries.

Job description

Dept: MA Utilization Programs

Rotating Saturdays, Holidays and Overtime as needed.

THIS POSITION IS REMOTE.

LOCAL CANDIDATES ONLY - Contractor must be of reasonable proximity to a client's Michigan office for IT support if needed.

Medical Management Intake Specialist
Work Hours:
• Schedule: Full-time, 40 hours per week
• Hours: Monday through Friday, 8:00 AM to 5:00 PM
• Flexibility: Schedules will include some Saturdays, Sundays, and Holidays; overtime may be necessary
Required Skills and Experience:
• Minimum of 2 years of experience in a healthcare, insurance, or related field
• High school graduate and college or university experience
• Medical terminology knowledge or a medical background is required
• Strong understanding of health insurance processes, including claims management, benefits coordination, and prior authorization procedures
• Customer service experience is required
• Strong phone skills with experience handling inbound and outbound calls
• Experience with healthcare management software and databases
• Excellent verbal and written communication skills
• Ability to explain complex information in a clear and concise manner
• Strong problem-solving skills with the ability to analyze data and identify trends
• Attention to detail and accuracy in all work
• Ability to work collaboratively with cross-functional teams
• Demonstrated ability to build and maintain positive relationships with colleagues, clients, and stakeholders
Highly preferred:
• Two years of college or associate level degree equivalent
• Experience with providing high quality, provider focused servicing to facilities and doctors
• Work collaboratively as a team member with peers and nurses
• Concisely and accurately enter documentation into Care Advance
• Effectively engage over the phone via both inbound and outbound with providers
• Process provider requests as needed
• Acts as providers first trusted source for UM Prior Auth programs
• Assign faxes to designated staff
• Process requests for compliance inquiries
• Access various UM department mailboxes and voicemail as needed
• Ability to function independently
• Critical Thinking
• Bi-Lingual/Spanish

Required profile