- High School Diploma or GED.
- 1+ years of related experience including customer or provider service experience, including experience developing customer relationships via telephone, obtaining necessary information and accurately documenting conversations and health insurance or health care industry experience.
- Experience working within a production environment with production & quality metrics.
- Demonstrated ability to apply critical thinking to resolve issues and conflicts while maintaining composure and confidence.
- Ability to prioritize work and meet deadlines.
- Strong written and verbal communication skills with the ability to effectively communicate to varying audiences.
- Proficiency with Microsoft Office applications.
- Excellent attendance and punctuality.
- Must be comfortable working in a high volume, fast paced call center environment.
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Health Services Intake Specialist - Des Moines, United States - Wellmark
Description
Company DescriptionWhy Wellmark: We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we've built our reputation on over 80 years' worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors-our members. If you're passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today
Learn more about our unique benefit offerings here.
Want to know more? You can learn about life at Wellmark here.
Job Description
About the Role: We're looking for a Health Services Intake Specialist to work within a call center setting facilitating care management functions, including eligibility and benefit verification, authorization status inquiries, data collection/documentation and accurate completion of precertification and notification requests. This individual will provide administrative support to care management teams and contribute to corporate and department objectives by processing incoming care management requests in a prompt, professional and courteous manner.
About You: Are you excited about the opportunity to advocate for stakeholders through collaboration with multi-disciplinary teams? Are you able to manage a large variety of responsibilities while staying organized? Do you enjoy researching within guideline documentation and making decisions based on what you find? If you are a dedicated, customer-focused health care professional motivated and inspired by the opportunity to provide administrative support to care management teams in a fast-paced production environment, consider applying today
This role will require training for the first 6 weeks from our Des Moines, Iowa office. After a successful training period, you will eligible to work remote every day*, or a hybrid office/home schedule based on your preference.
*Remote eligibility subject to change based on business needs.
Qualifications
Required Qualifications:
What you will do as a Health Services Intake Specialist:
a. Verify member eligibility and benefits as well as provider participation and network status.
b. Perform accurate, timely documentation of information received via phone, fax, or provider portal within JIVA. Ensure accuracy of information through strong communication skills and adherence to department guidelines.
c. Support the Nurse Care Managers by manually creating episodes for services and admissions that will be reviewed for medical necessity. Create and send letters to providers and/or members to communicate authorization request outcomes.
d. Manage workload within regulatory turnaround time requirements and mandated timeframes for processing cases.
e. Provide accurate information to members and providers by utilizing up to date guidelines and job aides. Meet both quality assurance and production metrics established by the Health Services department.
f. Demonstrate understanding and accurate interpretation of regulatory and accreditation standards, Health Services guidelines, and HIPAA requirements.
g. Comply with regulatory standards, accreditation standards and internal guidelines; remains current and consistent with the standards pertinent to utilization management services.
h. Other duties as assigned.
An Equal Opportunity Employer
The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.
Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at
Please inform us if you meet the definition of a "Covered DoD official".
