Intake Specialist I

Specialist

Remote

May 21, 2026

Job Description

REQUIREMENTS

High School Diploma or equivalent required
Minimum of one (1) year of clinical, insurance, healthcare, or related experience preferred
Managed care experience preferred
Proficiency in Microsoft Office and Windows-based computer systems
Strong analytical and problem-solving skills
Excellent verbal and written communication skills
Ability to work independently and collaboratively in a team environment
High attention to detail and accuracy
Professional phone etiquette and customer service skills
Critical thinking and decision-making abilities
Adaptability and resilience in a changing environment
Knowledge of behavioral health systems preferred
Ability to clearly summarize and communicate information in written format

RESPONSIBILITIES

Convert information received from providers or members via fax, phone, portal, or mail into electronic records while verifying:
- Member eligibility
- Provider network status
- Benefit coverage
Review requests and return notifications for:
- Ineligible members
- Duplicate requests
- Services not covered under medical benefits
Facilitate authorization of benefits for participating and out-of-network providers, including:
- Completing and distributing appropriate forms
- Generating approval letters
Enter prior authorizations into medical management systems when approval is appropriate according to SOP guidelines
Route prior authorizations requiring medical necessity review to the appropriate clinical care reviewer
Communicate with providers regarding authorization requests and troubleshoot related issues
Ensure all inquiries and submissions received via fax, email, phone, or provider portal are addressed within state-mandated turnaround times
Cross-train across departments for all Medicaid and Marketplace products
Collaborate with internal departments to resolve issues, overrides, and questions
Facilitate inbound and outbound communication with providers to obtain additional information required for UM processes, including:
- New provider submissions
- Newborn notifications
- Clinical documentation
Provide authorization information to providers, facilities, and members
Support the Clinical team to ensure authorization requests requiring review are processed timely
Monitor workload aging and respond with appropriate urgency
Meet departmental productivity and quality standards
Maintain knowledge of assigned market processes and procedures
Adhere to all departmental and company policies and procedures
Perform additional duties as assigned