Sunshine State Health Plan Hiring for Intake Representative II at Florida Full Time

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: The Intake Representative II enters specific information from physicians’ requests into a medical management authorization system, achieving required production/quality standards. Must have exhibited successful performance at an Intake Representative I level. May be required to perform duties within sub-departments such as Right of First Refusal (ROFR), Research and Repair and Quality Control (Q/C).

• Validate patient & medical provider demographic information including selection of a medical provider by specialty for healthcare service
• Determine the patients’ status/eligibility, the Primary Care Manager type, and the appropriate referral/authorization
• Contact provider offices and make confirmation calls to patients for all urgent requests. Make sound decisions to keep the referral/authorization process moving according to contractual standards
• Follow instructions, including redirecting patients into the provider network for care, per contractual standards
• Summarize referral/authorization requests and prepare correspondence to provide clinical information to servicing providers
• Generate letters and validate correct providers/patients, demographics and reason(s) for services to be rendered are correct
• Maintain production reports on closed transactions, duplicate transactions and requests
• Review situations, objectively identify problems, recognize patterns and determine solutions
• Work as a team member; collaborate with co-workers, and take responsibility for achieving outstanding customer service
• ROFR

o Read/understand the MTF capability report; communicate with requesting provider for determination/clarity of requested services; recognize continuity of care as defined by specific criteria; communicate with MTF on capability of performing requested services for care from the civilian provider; track and monitor response from the MTF as required by contract; enter disposition of care coordination in the medical management system & ROFR database

• Research/Repair

o Research other applications/systems to determine current provider & patient demographics; communicate with providers, patients & MTF to determine correction or update of existing authorizations; edit authorization as needed based on specific criteria, work instructions & correction of errors; draft letters and emails external from the medical management authorization system as needed.

• Q/C

o Work is accurate according to audit standards; mentor new staff; provide chair side training; research using information within other fields for editing request; retrieve documentation from subcontractor’s database.

• Authorizations/Referrals

o Enter all authorization/referral type requests (DME, BH, and outpatient); pre-screen patient demographics (as needed) in support of front-end processes; support QC process & trainees

Education/Experience: High School diploma or equivalent; college course work. Minimum two years experience in a production/data entry environment in managed care, claims/billing, health insurance, customer service, call center, or claims office

License/Certification: Medically based trade school diploma/certification desired.

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.