SWHRCIN INTAKE SPECIALIST SWHR CIN

Qualifications

• High School Diploma or equivalent required
• Associates Degree preferred

• 2 years full time medical referrals and preauthorization experience in a healthcare setting required and
• 2 years customer service experience in a healthcare setting required

Position Responsibilities The Intake Specialist will be responsible for processing precertification and referral requests for health care services. The duties of this position will include but are not limited to verifying plan coverage/PCP, securing patient demographics, referring physician, current health status including clinical history/physical information, status of admission or discharge and requested procedures. This position will be responsible for reviewing, triaging, and processing precertification and referrals. The Intake Specialist will be responsible for accuracy and completeness of precertification and referral information within the database in accordance to all compliance and regulatory requirements. This role is responsible for communicating authorization information to appropriate individuals within the specified timeframe, inclusive of internal and external clients. The Intake Specialist will respond to inquiries and provide additional information to physicians as needed.  They will make outreach calls to providers, facilities, office staff, and/or Case Managers to obtain any clinical rationale, or status updates for UM/UE requests. The Intake Specialist will review requests for appropriate network utilization and will re-direct cases as needed. The Intake Specialist will be responsible for handling volume of inbound and outbound calling from and to providers and members as needed. This position is responsible for providing excellent customer service in handling these calls. They will effectively communicate results to executive management, internal and external clients, and maintain a positive attitude while working in a dynamic, fast-paced environment. The Intake Specialist will adhere to all regulatory and delegation requirements, including turn-around time.

In addition to the required qualifications, a successful Intake Specialist  will

• Performs high level of data entry
• Meets any intake production or QA metrics
• Responsible for processing, entering, triaging and routing all precertification and referral requests.
• Responsible for following all compliance and regulatory requirements for turn-around time, notification to provider/member, and accuracy/completeness

• Updates Care Management appropriate wrap-up codes, break/lunch codes and any other codes for accurate and complete reporting when handling volume of inbound phone calls
• Uses interpersonal/communication strategies with individuals to achieve: (a) desirable/acceptable outcomes /responses (b) perceptions of satisfaction or acceptance of those involved
• Perform procedures required by the assignment: (a) safely, without causing harm (b) effectively, achieving the intended outcome/result (c) efficiently, using the fewest possible resources (d) legally, within the scope of practice/policy
• Completes all compliance, regulatory and process training within specified timeline

Do you still have questions or concerns? Feel free to email your questions to recruitment@texashealth.org.