Behavioral Health - Intake Specialist 150-1010

About the Role

Responsible for providing customer service support for behavioral health benefits, directing members to appropriate in-network services, processing prior authorizations according to CMS and State regulations, sending provider faxes and member letters, and resolving behavioral health-related situations that arise from calls.

Responsibilities

• Available for telephone support from 8 AM to 5 PM (excluding lunch and breaks) to address behavioral health needs across all lines of business.
• Resolves various types of phone calls, including but not limited to referrals, authorizations, and verifying member eligibility, line of business, and network affiliations for members and providers.
• Determines if a call is clinical and requires transfer to clinical staff.
• Informs callers (members, facility personnel, physicians, or other healthcare professionals) of utilization requirements and procedures.
• Makes initial referrals that do not require evaluation or interpretation of clinical information to behavioral health services.
• Completes appropriate electronic certification and progress notes documentation as needed.
• Assists with specialized tasks such as claims corrections, follow-up on provider/member questions regarding claims payments, generating provider faxes, generating member letters, and other administrative tasks.
• Handles disgruntled or upset members professionally.
• Performs other duties as required.

Qualifications

• Basic punctuation and grammar skills.
• Ability to multi-task and manage time efficiently.
• Proficient in Microsoft applications.
• Ability to work independently and apply good judgment.
• Ability to maintain and preserve highly confidential information.
• Strong oral communication skills.
• Successful completion of a Health Care Sanctions background check.

Education/Experience

• High school diploma or equivalent.
• Customer service, office management, and/or healthcare experience preferred but not required.