Overview

Completes data input for authorization/service requests. Works collaboratively with other departments to troubleshoot and resolve authorization related issues in a timely and efficient manner. Ensures timely and effective delivery of services. Works under general supervision.

Responsibilities
Creates and modifies authorizations and/or orders for new and existing Members in an accurate and timely matterResearches, troubleshoots, resolves authorization and/or order processing issues and discrepanciesCompletes activities, including but not limited to, inbound/outbound calls, as assigned, faxes and emailsObtains information from internal and external sources. Processes or triages the request via our medical management information system or external sourcesCoordinates with Providers and Members regarding authorization requests and/or activitiesCommunicates with Care Management, Member Services, Membership and Eligibility and other internal departments regarding Member services, authorization requests and issuesReviews all authorization requests for accuracy and prioritizing based on urgencyDocuments communication, actions taken and barriers in the Medical Management System as it pertains to the Members Care or request for servicesUtilizes internal and external systems to verify eligibility and Provider Information such as name, address, fax number, NPI and TAX ID.Conducts follow-up, as necessary, to ensure member satisfaction and successful delivery of serviceProtects the confidentiality of member information and adheres to company policies regarding confidentiality.Performs other duties and special projects, as assigned
Qualifications

Education:  High School degree or equivalent required. 

Experience:  Minimum of two years of experience in a customer service role required.  Excellent oral and written communication skills required.  Advanced personal computer skills, including Word, Excel or Access required.  Utilization Management experience preferred.