Company :

Job Description : 

JOB SUMMARY

This job is responsible for completing all Prior Authorization outbound call tasks and/or inbound triage case creations.  In compliance with regulatory guidelines (e.g., NCQA, CMS), the incumbent informs the member and/or provider of the approval and/or denial of the requested authorization. 

ESSENTIAL RESPONSIBILITIES

• Obtain call task from Utilization Management platform, perform verbal outbound call task requirement following a detailed script and desk level procedure, and appropriately log result within the platform. 
• Obtain triage task from Utilization Management platform and follow a detailed desk level procedure to enter the required fields to set up the case build (data entry) and set the urgency of the case creation for the Intake Coordinator.  
• Other duties as assigned or requested.

EXPERIENCE

Required

• None

Preferred

• 1 year of Customer Service experience
• 1 year of Call Center experience
• 1 year of Healthcare experience

SKILLS

• Possess good written and oral telephonic communication skills
• Ability to navigate through multiple systems simultaneously
• Knowledge of administrative and clerical procedures and systems such as word processing, managing files and digital fax
• Ability to interact well with peers, supervisors, and customers

EDUCATION

Required

• High School Diploma

Preferred

• None

LICENSES or CERTIFICATIONS

Required

• None

Preferred

• None

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office- or Remote-based

Physical work site required

Constantly

Travel Required

0% - 25%

Audible Speech

Frequently

Hear

Frequently

Position self or move lower on ground, under tables/desk, etc.

Occasionally

Climb

Occasionally

Drive

Never

Reach

Occasionally

Sedentary Position

Constantly

Move

Occasionally

Repetitive Motion

Constantly

Use Hands/Fingers to Handle or Feel (beyond data entry)

Occasionally

Vision - Distinguish Color

Occasionally

Vision - Far, near, Depth Perception

Occasionally

Lifting: up to 10 pounds

Constantly

Lifting: up to 20 pounds

Occasionally

Lifting: up to 50 pounds

Never

Lifting in excess of 50 pounds

Never

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

Pay Range Maximum:

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.  The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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For accommodation requests, please contact HR Services Online at [email protected]

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