COMPANY OVERVIEW

Zing Health is a tech-enabled insurance company making Medicare Advantage the best it can be for those 65-and-over. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health aims to return the physician and the member to the center of the health care equation. Members receive individualized assistance to make their transition to Zing Health as easy as possible. Zing Health offers members the ability to personalize their plans, access to facilities designed to help them better meet their healthcare needs and a dedicated care team. For more information on Zing Health, visit www.myzinghealth.com.

SUMMARY DESCRIPTION:

The Intake Coordinator will provide internal support to the Health Services Department  and may be assigned in the areas of Utilization Management, Case Management or Appeals & Grievances ensuring all  services for which prior authorization or case management is requested or an appeal or grievance filed are reviewed according to plan required and approved criteria.

ESSENTIAL FUNCTIONS: 

• Initiate authorization requests for outpatient and inpatient services in accordance with the prior authorization list. Route to appropriate staff when needed.
• Initiate case management referral case set-up for cases referred to case management. Route to appropriate staff when needed.
• Initiate pre-service and post-service appeal requests in accordance with guidelines for appeals review and processing. Route to appropriate staff when needed.
• Initiate grievance processing in accordance with guidelines for grievance review and processing. Route to appropriate staff when needed.
• Answers phone queues and processes faxes within established standards.
• Data enters authorizations, appeals & grievances, and case management cases in the documentation systems.
• Screen requests for eligibility and benefits.
• Screen requests for required documentation and requests required documentation as needed.
• Fully understands policies, procedures and operations of Zing Health.
• Effectively communicates to management and internal departments timely.
• Receives and responds to all incoming calls from PCPs, specialists, other providers, electronic notification applications, members, authorized representatives, etc. regarding inpatients, surgeries, and outpatient services including DME, Home Health Care and other services requiring a pre-authorization.
• Performs other duties, projects and actions as assigned.
• Interacts with Medical Directors, Pharmacists, Behavioral Health Clinicians, Other Care Management Team Members and Zing internal departments.
• Performs other duties, projects and actions as assigned.

QUALIFICATIONS AND REQUIREMENTS:

JOB REQUIREMENTS:

Required Qualifications

• High school diploma or equivalent experience.
•  2+ years of relevant professional experience including managed care.
• Demonstrate effective verbal and written communication skills.
• Demonstrate excellent organizational skills.
• Demonstrate analytic skills when problem solving.
• Proficient in MS Office Applications and ability to learn department and job specific software systems.
• Demonstrate high attention to detail and a high degree of accuracy.
• Able to switch priorities in a positive and effective manner when directed by Company leadership.
• Able to effectively communicate technical concepts with team members and basic business concepts with team members and internal customers.



• Preferred Qualifications

• Knowledge of medical terminology preferred.
• Bilingual – English and Spanish
• Knowledge of current care management application.
• Experience in managing complex or catastrophic cases.
• Personal management skills — Plan and manage multiple assignments and tasks, set priorities and adapt to changing conditions and work assignments.
• Teamwork —ability to work well with one or more groups.
• Interpersonal effectiveness — Relate to co-workers and build relationships with others in the organization.
• Strong work values — Dependability, honesty and a positive attitude.