PEHP Health & Benefits is a division of the Utah Retirement Systems that proudly serves Utah’s public employees through high quality and competitively priced medical, dental, life, and long-term disability insurance plans on a self-funded basis.   As a government entity, we embrace both a public mission and a commitment to creating customer value, excelling in the market, and improving healthcare. We offer a competitive salary with generous benefits, personal development in a positive team environment, and excellent work-life balance. 

For most jobs, remote work is available for 9 out of every 10 workdays.

This is a part-time, non-benefited position.  Averaging less than 20 hours/week.

POSITION SUMMARY

PEHP’s Intake Team plays a mission critical role in PEHP’s centralization of core operational functions by processing all inbound documents. The Intake Specialist is responsible for reviewing, approving, and processing routine forms, ensuring that data is accurately loaded into the system, and forwarding documents to other departments as appropriate. The Intake Specialist must understand PEHP forms, processes, and operation systems. Successful performance of this position requires a high-level of commitment, attention to detail, and a willingness to understand the various programs and processes within PEHP.   

ESSENTIAL JOB FUNCTIONS AND DUTIES

1. Performs daily activities and functions of:
   1. Processing routine data and forms related to demographics, enrollment, prior authorization, and provider contracting when submitted electronically, including the Message Center, or by paper. Ensuring routine forms are accurate and complete before processing. Ensuring approved forms are accurately loaded into the system. When applicable, finalizes entity records loaded into the system
   2. Reviewing, indexing, and routing of documents submitted to PEHP by:
      1. Indexing files into document retention systems.
      2. Creating and finalizing entity records and initiating workflows within the PEHP core administration systems.
      3. Determining system processes and routing workflows to appropriate departments, including:
         1. Claims submissions.
         2. Appeals and payment correction requests.
         3. Recovery requests for overpayments, subrogation, and third-party liability.
         4. Returned mail.
         5. Incoming scanned mail.
         6. Documents related to enrollment, prior authorization, and provider contracting that contain data or forms that are not routine.
2. Adheres to established guidelines and standard operating procedures to enhance efficiency and maintain compliance of internal and external service levels.
3. Performs data processing and record finalization while verifying and ensuring accuracy of information within the system and assures timely handling of documents by:
   1. Reviewing daily, weekly, monthly, and quarterly reports on all key performance indicators.
   2. Responding to requirements, goals, priorities, and review of input data as assigned by the Intake Supervisor.
4. Maintains regular and reliable attendance.
5. Maintains strict confidentiality.
6. Performs other related duties as required.

Education and Experience

High school diploma or equivalent. 

PEHP experience is preferred.

Knowledge, Skills, and Abilities

This list contains knowledge, skills, and abilities that are typically associated with the job. It is not all-inclusive and may vary from position to position:

Required technical skills include the working knowledge and ability of:

• Various office management software systems related to alpha-numeric and document management.
• Ten-key operation.
• Microsoft Office Suite.

Required mathematical skills include working knowledge of:

• Calculating figures and amounts such as discounts, percentages, fractions, and ratios.

Required working knowledge of:

• PEHP claims adjudication policies, procedures, and processes.
• Intricacies related to medical and dental claims.
• PEHP enrollment processes.
• Basic medical and dental terminology.
• PEHP Medical, Dental, Life, Long Term Disability, Accidental Death & Dismemberment, and Pharmacy benefits, policies, limitations, and exclusions.
• PEHP appeals process policies.

Must possess excellent communication skills:

• Ability to read, analyze, and interpret software operational procedure manuals, technical procedures, and regulations.
• Interpersonal communication skills and public relation skills.
• Communicate effectively verbally and in writing.

Must have the ability to:

• Follow written and verbal instructions.
• Prioritize work.
• Review reports.
• Perform within deadlines.
• Work well in a team environment as well as independently.
• Multi-task by handling a variety of duties in a timely and efficient manner.
• Follow through with assignments.
• Deal effectively with stress caused by workload and time deadlines.

The incumbent must always demonstrate judgment, high integrity, and personal values consistent with the values of URS.

Work Environment

Incumbent performs in a typical office setting with appropriate climate controls. Tasks require a variety of physical activities which do not generally involve muscular strain, but do require activities related to walking, standing, stooping, sitting, reaching, talking, hearing, and seeing. Common eye, hand, finger dexterity required to perform essential functions.