Note: The job is a remote job and is open to candidates in USA. CareSource is a healthcare organization that is seeking an Intake Specialist I for their Utilization Management department. The role involves handling authorization requests from providers, processing these requests into their systems, and ensuring that all communications and inquiries are addressed in a timely manner.
Responsibilities
- Convert information obtained from providers/members, (received via fax, phone, portal or mail) into electronic records while verifying member eligibility, provider network status, and benefit coverage
- Review requests and send fax back for ineligible members, duplicate requests and items not covered by medical benefit
- Facilitate the authorization of benefits for participating and out-of-network providers including completion of appropriate forms that are distributed to physicians’ offices, provider relations and the generation of approval letters
- Place prior authorizations when approval is appropriate per SOP in the medical management systems
- Initiate process for routing prior authorizations requiring medical necessity review by clinical care reviewer
- Communicate with providers regarding prior authorization requests and troubleshoot issues from providers
- Ensure all methods of inquiries (fax, e-mail, phone and provider portal) and submissions are addressed within the state mandated timeframes
- Cross train interdepartmentally for all Medicaid and Marketplace products
- Collaborate across company departments to assist with issues, overrides, and questions
- Facilitate inbound and outbound contact with providers to obtain any and all additional information that may be required for UM processes (new provider submissions, newborn notifications, etc.)
- Provide authorization information to provider, facilities and/or members
- Assist Clinical team as directed to ensure requests for authorization that require clinical review are received and processed timely
- Maintain awareness of current workload aging and respond with appropriate sense of urgency
- Expectation to meet department standards and goals
- Maintain knowledge and understanding of all processes and procedures for assigned market
- Adhere to all departmental and company policies and procedures
- Perform any other job related instructions, as requested
Skills
- High School Diploma or equivalent
- Minimum of one (1) year of clinical and/or insurance experience, or related healthcare
- Managed care experience
- Medical Terminology Certificate
Benefits
- You may qualify for a bonus tied to company and individual performance.
- Substantial and comprehensive total rewards package.
Company Overview
CareSource provides managed care services to Medicaid beneficiaries. It was founded in 1989, and is headquartered in Dayton, Ohio, USA, with a workforce of 1001-5000 employees. Its website is https://www.caresource.com/.Company H1B Sponsorship
CareSource has a track record of offering H1B sponsorships, with 9 in 2025, 39 in 2024, 35 in 2023, 22 in 2022, 37 in 2021, 28 in 2020. Please note that this does not guarantee sponsorship for this specific role.
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