Health Services Intake Specialist

Summary

Join Wellmark as a Health Services Intake Specialist and facilitate care management functions within a call center environment. You will verify eligibility and benefits, perform accurate documentation, support nurse care managers, manage workload within regulatory requirements, and provide accurate information to members and providers. This role requires strong communication and critical thinking skills, proficiency with Microsoft Office applications, and experience in customer or provider service. After a six-week training period in Des Moines, Iowa, you will have the option to work remotely or utilize a hybrid schedule. The position involves working in a fast-paced, high-volume call center setting and adhering to quality and production metrics.

Requirements

• High School Diploma or GED
• 1+ years of related experience including customer or provider service experience, including experience developing customer relationships via telephone, obtaining necessary information and accurately documenting conversations and health insurance or health care industry experience
• Experience working within a production environment with production & quality metrics
• Demonstrated ability to apply critical thinking to resolve issues and conflicts while maintaining composure and confidence
• Ability to prioritize work and meet deadlines
• Strong written and verbal communication skills with the ability to effectively communicate to varying audiences
• Proficiency with Microsoft Office applications
• Excellent attendance and punctuality
• Must be comfortable working in a high volume, fast paced call center environment

Responsibilities

• Verify member eligibility and benefits as well as provider participation and network status
• Perform accurate, timely documentation of information received via phone, fax, or provider portal within JIVA. Ensure accuracy of information through strong communication skills and adherence to department guidelines
• Support the Nurse Care Managers by manually creating episodes for services and admissions that will be reviewed for medical necessity. Create and send letters to providers and/or members to communicate authorization request outcomes
• Manage workload within regulatory turnaround time requirements and mandated timeframes for processing cases
• Provide accurate information to members and providers by utilizing up to date guidelines and job aides. Meet both quality assurance and production metrics established by the Health Services department
• Demonstrate understanding and accurate interpretation of regulatory and accreditation standards, Health Services guidelines, and HIPAA requirements
• Comply with regulatory standards, accreditation standards and internal guidelines; remains current and consistent with the standards pertinent to utilization management services
• Other duties as assigned

Benefits

After a successful training period, you will be eligible to work remotely each weekday*, or a hybrid office/home schedule based on your preference