Job description
24 Seven is partnering up with a large healthcare company to help them find a Clinical Intake Specialist to join their team in this remote position. You must reside in one of the 4 states, Oregon, Washington, Utah or Idaho. This is 6 month contract that is likely to extend. While on contract, you'd be eligible for benefits including medical, dental, vision, sick time, 401K and holiday pay.Top 3 skills for the role: Demonstrate knowledge of medical terminology, anatomy, and coding, previous professional experience in health insurance or provider’s office (scheduling, front office, etc), Auditing/ Quality Assurance
Job Description:
The Clinical Intake Specialist receives, researches, and takes initial action related to documentation and requests from a variety of sources related to Utilization Management (UM) Care Management (CM), and Disease Management (DM) programs. Does not make clinical decisions, but partners with licensed health professionals on appropriate actions and responses. They are responsible for both initial research related to requests and preparing follow-up correspondence to members and/or providers once a determination is made.
Requirements:
- Effective communication and writing skills.
- Strong customer service skills including listening, patience, empathy, maintaining confidentiality, and focus on meeting customer needs.
- Intermediate computer skills (e.g. Microsoft Office, Outlook, Internet search) and experience with health care systems and documentation (EMR, billing and claims).
- Strong organization, data entry, and administrative skills.
- Demonstrated knowledge of medical terminology, anatomy and coding (CPT, DX, HCPCs).
- Ability to investigate and research issues related to clinical programs and work with clinical staff to resolve.
- Ability to work independently, to prioritize work, meet deadlines and achieve operational standards.
- Ability to work effectively in a team environment.
- Ability to research complex inquiries and coordinate with appropriate staff to complete work.
- Strong business writing skills and ability to compose written responses to members or providers.
- Ability to mentor and support co-workers, and provide training to new team members.
The Clinical Intake Specialist would have a high school diploma or GED, and at least 1 year experience as a Clinical Intake Specialist or equivalent combination of education and experience.
General Functions in this role:
Adheres to dependability, customer focus, and all performance criteria as established by the department including: timeliness, production, and quality standards for all work.
Utilizes knowledge and understanding to research simple to moderately complex documentation and requests related to UM processes and requirements, and CM and DM programs from members, providers, employer groups, agents, member representatives and internal customers.
Reviews requests for completeness of information and identifies additional information needed to initiate the request and asks for it when appropriate, but does not perform any activities that require evaluation or interpretation of clinical information.
Validates preauthorization requirements, member benefits, eligibility, and documents information in the appropriate system. Identifies errors promptly and determines what corrective steps may be taken to resolve errors.
Creates cases for UM, CM, DM in the Care Management System as appropriate. May administratively authorize services as directed by Clinical Services Management.
May coordinate case information in external vendor systems for Medical Director Reviews, as necessary.
Receives medical inpatient admission and discharge notifications, documents admission and discharge notifications as necessary for UM and CM use.
Coordinates reviews with members, providers, clinical staff, other departments, and vendors in order to process the request and provide a complete response, as necessary.
Follows strict guidelines to ensure all work meets corporate standards for accuracy, timeliness, quality and compliance with federal, state, BCBSA and accreditation regulations. Organizes and keeps readily accessible all reference documents, policies and procedures needed to accomplish this.
Facilitates the member’s or provider’s understanding of the preauthorization process and of the information necessary to effectively process a preauthorization, as needed.
Utilizes knowledge and understanding to research difficult or complex documentation and requests related to UM processes and requirements, and CM and DM programs from members, providers, employer groups, agents, member representatives and internal customers.
Drafts written notifications in compliance with all regulatory and quality entities to members and providers to request medical records and additional information, communicate UM determinations, cancellations, and other necessary communications.
Tracks and monitors individual timeliness of UM reviews to ensure all Regulatory and Quality timeliness requirements are met.
Acts as a role-model for other specialists; demonstrates and promotes an ethical work environment with internal and external contacts.
Assists with coaching, mentoring, and training, as directed by Supervisor. Helps to answer questions for all levels of staff.
Performs detailed research and problem solving using sound decision-making skills after thoroughly researching the facts.
Participates in quality activities, task forces or work groups, or other training and/or process improvement teams.
Assumes a leadership role in identifying areas for improving the systems necessary to perform work and make appropriate recommendations. May assist with systems testing if applicable.
Expired job