Clinical Services - Intake Coordinator

Clinical Services-CW - Intake Coordinator

This job captures all inbound appeals and grievance requests from providers and/or subscribers. The incumbent assesses the request, conducts all necessary research such as verifying benefit coverage for the patient, denial codes, par or non-par provider status and then creates the case (data entry) in the online processing system. Ensures all accurate information is entered at the onset of the process to ensure adherence to all regulatory compliance requirements and service level agreements. The requests may come via fax or mail and may require checking multiple systems. The incumbent is expected to meet established quality and production standards.

Essential Responsibilities:

• Obtain requests from provider, member or pharmacy via fax or mail.
• Use multiple software systems and various resource sites to determine the type of request (member or provider appeal).
• Build cases in the online processing system.
• Identify if the submission is additional information received for a current case. When necessary, forward to the responsible analyst.
• Ensure accuracy of data entry to prevent compliance and/or downstream process issues.
• Sort and scan incoming mail and mail correspondence to members and/or providers.
• Complete outbound calls when additional information is required.
• Identify expedited appeals based on key terms/phrases.
• Save medical information to disk.
• Other duties as assigned would consist of coding.

Required Qualifications:

• High School Diploma/GED
• 1 year of experience working in the Healthcare Industry
• Familiarity with medical terminology
• Reading comprehension
• Claims experience
• Oral & written communication skills
• Telephone skills
• Data entry skills
• Experience with Microsoft Office Suite (Word, Excel, and Outlook)
• Attention to detail
• Problem solving & decision making
• Compliance
• Experience in the Healthcare and/or Health Insurance industry

Preferred Qualifications:

• Coder experience would be a plus