Intake Agent Prior Authorization

Job Description
The Intake Agent - Prior Authorization is responsible for the efficient, accurate and timely prioritization and management of work. Provides support to the Prior Authorization Department in meeting client expectations regarding efficiency, service levels, privacy maintenance and quality of decision-making. Responsible for maintaining compliance with ERISA, CMS, and client specific requirements. Works as part of the team to meet business unit objectives. This position is also responsible for receiving calls from physician offices and providing professional and courteous assistance to all callers through the criteria-based process. The Intake Agent will follow criteria question set prompts to facilitate system-generated approvals. Further responsibilities include maintaining complete, timely, and accurate documentation of all requests, communicating to the physician’s office, pharmacies, intake etc. as needed, and transfers all clinical questions and judgement calls to the Pharmacy Technician or Clinical Pharmacist as needed. The Intake Agent will also assist with other duties such as outbound calls, monitoring/responding to inquiries in mailboxes and other duties as assigned by the leadership team. The Intake Agent will support requirements of the PA team by working as part of a weekend coverage team on a rotating basis where needed.

Required Qualifications
Ability to deal with a diverse customer base in a friendly and confident manner (internal and external customers). Proficient with computer systems and Microsoft Office skills, including Access, Excel and Word. Ability to navigate systems in Windows and web-based programs, and quickly learn new applications. Ability to prioritize and manage multiple tasks. Demonstrated sense of urgency with assignments. Excellent organization skills. Strong detail orientation.
Demonstrated problem-solving ability. Strong verbal and written communication skills. Ability to maintain confidentiality. Knowledge of claim adjudication processes. Works well as a member of a team with strong interpersonal skills. Seeks ways to collaborate and reach consensus with peers. Actively works to build strong working relationships.
Able to customize messages and deliver to broader audiences. Background in creating and maintaining reports a plus.

Preferred Qualifications
-Previous Healthcare Experience and/or Managed Care experience
-Previous Customer Service Experience
-Call Center Experience is a plus
-Excellent written and Verbal Communication Skills
-Ability to efficiently learn external software programs and multitask between several computer applications

Education
Verifiable High School Diploma or GED - Required
Associate's Degree or Bachelor's Degree - Preferred