Carelon Management Services LLC is seeking a Referral Services Assistant to join our Phone Team. In this role, you will be the first point of contact for providers and members, managing daily inbound calls related to prior authorizations. You will guide callers through the submission process, provide status updates, and collaborate across teams to resolve inquiries efficiently.
What You'll Do
- Handle daily inbound calls related to prior authorization requests.
- Guide callers through the process of submitting authorization requests.
- Assist with modifications or cancellations of existing authorizations.
- Communicate the status of authorization requests clearly and efficiently.
- Approve eligible authorizations in accordance with departmental guidelines.
- Collaborate with Production RSAs, clinical teams (RNs, MD reviewers), and internal support departments.
What We're Looking For
- Proven experience in a Call Center environment.
- Solid understanding of medical terminology.
- Background in the healthcare industry.
- Strong proficiency in navigating multiple systems and databases.
- Analytical mindset with strong problem-solving abilities.
- Ability to stay calm and professional in high-pressure situations.
- Demonstrates initiative, independence, and ownership in day-to-day tasks.
Nice to Have
- Prior Utilization Management (UM) experience.
Team & Environment
You will collaborate closely with Production RSAs, clinical teams (RNs and MD reviewers), and internal support departments.
Benefits & Compensation
- Hourly pay: $19.38/hr. - $25.50/hr.
Carelon Management Services LLC is an equal opportunity employer.
