Job Description

We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with us.

Residency in or relocation to Louisiana is preferred for all positions.

Applicants must be authorized to work for Louisiana Blue in the United States without employer-sponsored immigration support. Louisiana Blue will not provide current or future employment-based immigration sponsorship or other immigration support for this opportunity, including H-1B, L-1, O-1, H-1B1, E-3, TN, or J-1 sponsorship or F-1 OPT/STEM OPT/CPT support. Applicants who would require such sponsorship or employer support during their employment should not pursue this opportunity.

POSITION PURPOSE

Responds to provider requests telephonically and electronically for preauthorization of inpatient admissions and outpatient services and procedures. Verification of benefits, eligibility and provider network status. Promotes and maintains a positive company image through telephonic and electronic contact with internal and external customers.

NATURE AND SCOPE

• This role does not manage people
• This role reports to this job: SUPERVISOR, CLINICAL INQUIRY
• Necessary Contacts: All levels of BCBSLA personnel, providers, and subscribers; including Special Accounts, Member Service, Provider Service, Benefits Administration, Network Administration, Utilization Review Nursing Staff, Medical Directors, Medical Necessity Appeals, Administrative Appeals, Pharmacy and Providers staff.

QUALIFICATIONS

Education

• High School Diploma or GED required
• Some college course work preferred

Work Experience

• 1 year call center experience or prior knowledge of a health insurance pre-service authorization required

Skills and Abilities

• Excellent listening, reading, comprehension, oral and written communication skills required
• Effective organizational and interpersonal skills required
• Ability to multi-task and handle work independently as well as prioritize multiple customer issues required
• Working knowledge of relevant PC software (Microsoft Word and Excel) required
• Working knowledge of medical terminology required
• Must be able to verbally communicate on the telephone in a call center environment, approximately 95% of the time.
• Ability to sit at a desk and answer calls for prolonged periods of time with pre-determined breaks required
• Facets experience preferred

Licenses and Certifications

• None Required

ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS

• Responds to provider requests telephonically and electronically for preauthorization of inpatient admissions and outpatient services and procedures. Verifies benefits, eligibility and provider network status. Responsible for meeting targets for staff and unit performance as required by company and management standards to ensure achievement of departmental productivity goals
• Receives member clinical data, enters relevant case information and follows departmental processes to authorize services as appropriate. If processes do not allow approval, forwards cases and attached clinical data to the appropriate Utilization Review team. Ensures authorizations are conducted in a manner that minimizes any disruption in the provision of healthcare, standardizes the timeliness of the decisions and maintains flexibility to accommodate providers’/members’ needs to help ensure customer satisfaction
• Responsible for timely management of appropriate verbal notifications and/or written materials to ensure compliance with regulatory and/or operational guidelines
• Maintains thorough knowledge of required lines of business, changes to recent laws and regulations, standard data exchange code sets, medical terminology, computer systems and Care management and URAC policies and procedures to ensure consistency in delivery of excellent customer service and accreditation compliance
• Accountable for special assignments/projects as requested by management
• Accountable for complying with all laws and regulations associated with duties and responsibilities

Additional Accountabilities and Essential Functions

The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions

• Perform other job-related duties as assigned, within your scope of responsibilities.
• Job duties are performed in a normal and clean office environment with normal noise levels.
• Work is predominately done while standing or sitting.
• The ability to comprehend, document, calculate, visualize, and analyze are required.

An Equal Opportunity Employer

All internal employees please apply through Workday Careers.

PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI)

Additional Information

Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.

If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.

In support of our mission to improve the health and lives of Louisianians, we encourage the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.

We perform background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.

Additionally, we are a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.