Intake Specialist 150-1010

Behavioral Health - Intake Specialist

Job Summary

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 from calls.

Key Responsibilities

• Provide telephone support from 8 AM - 5 PM (excluding lunch and breaks) for behavioral health needs across all lines of business.
• Resolve various phone call types, including referrals, authorizations, verifying member eligibility, and network affiliations for members and providers.
• Determine if a call is clinical and requires transfer to clinical staff.
• Inform callers (members, facility personnel, physicians, other healthcare professionals) of utilization requirements and procedures.
• Make initial referrals to behavioral health services that do not require evaluation or interpretation of clinical information.
• Complete appropriate electronic certification and progress notes documentation.
• Assist with specialized job tasks such as claims corrections, following up on provider/member questions regarding claims payments, generating provider faxes, generating member letters, and other administrative tasks.
• Manage calls from disgruntled or upset members.
• Perform other duties as required.

Requirements & Tech Stack

• 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 information of a highly confidential nature.
• Possess strong oral communication skills.
• Successful completion of Health Care Sanctions background check.

Qualifications

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