Job Description
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The job is a remote job and is open to candidates in USA. CareSource is a healthcare organization that is seeking an Intake Specialist I for their Utilization Management department. The role involves handling authorization requests from providers, processing these requests into their systems, and ensuring that all communications and inquiries are addressed in a timely manner. Responsibilities Convert information obtained from providers/members, (received via fax, phone, portal or mail) into electronic records while verifying member eligibility, provider network status, and benefit coverage Review requests and send fax back for ineligible members, duplicate requests and items not covered by medical benefit Facilitate the authorization of benefits for participating and out-of-network providers including completion of appropriate forms that are distributed to physicians’ offices, provider relations and the generation of approval letters Place prior authorizations when approval is appropriate per SOP in the medical management systems Initiate process for routing prior authorizations requiring medical necessity review by clinical care reviewer Communicate with providers regarding prior authorization requests and troubleshoot issues from providers Ensure all methods of inquiries (fax, e-mail, phone and provider portal) and submissions are addressed within the state mandated timeframes Cross train interdepartmentally for all Medicaid and Marketplace products Collaborate across company departments to assist with issues, overrides, and questions Facilitate inbound and outbound contact with providers to obtain any and all additional information that may be required for UM processes (new provider submissions, newborn notifications, etc.) Provide authorization information to provider, facilities and/or members Assist Clinical team as directed to ensure requests for authorization that require clinical review are received and processed timely Maintain awareness of current workload aging and respond with appropriate sense of urgency Expectation to meet department standards and goals Maintain knowledge and understanding of all processes and procedures for assigned market Adhere to all departmental and company policies and procedures Perform any other job related instructions, as requested Skills High School Diploma or equivalent Minimum of one (1) year of clinical and/or insurance experience, or related healthcare Managed care experience Medical Terminology Certificate Benefits You may qualify for a bonus tied to company and individual performance.
Substantial and comprehensive total rewards package. Company Overview CareSource provides managed care services to Medicaid beneficiaries. It was founded in 1989, and is headquartered in Dayton, Ohio, USA, with a workforce of 1001-5000 employees. Its website is Company H1B Sponsorship CareSource has a track record of offering H1B sponsorships, with 9 in 2025, 39 in 2024, 35 in 2023, 22 in 2022, 37 in 2021, 28 in 2020. Please note that this does not guarantee sponsorship for this specific role.