Intake Specialist

Avera•Sioux Falls, SD

12d•Hybrid

About The Position

Acts as the primary access point for customers and referral sources. Serves as primary intake person for incoming requests for multiple sites and appropriately screens incoming referrals and responds in priority levels as set forth by the Access Services Manager. Registers the patient in the computer system utilizing multiple resources to gather information. Forwards multi-discipline orders to appropriate sites and completes any other necessary steps to facilitate a timely hand-off. Completes insurance eligibility and benefit verification, gathers medical necessity documentation, and negotiates pre-authorization as necessary. Maintains current knowledge base of all payer’s unique rules/regulations, coverage criteria, payer contracts and in-network providers. Reviews documentation and determines medical necessity coverage per specific payer guidelines and completes Advance Beneficiary Notices (ABN)/waivers when required. Maintains an up-to-date knowledge of products and services and coverage area. Utilizes workflow software to track all orders for the purpose of performance productivity, responsiveness, and quality standards and productively participates in continuous quality improvement efforts to streamline workflows, so as to maximize effectiveness and efficiency. Ensures compliance with state, federal, and accreditation regulatory requirements. Achieves and maintains a thorough knowledge base of the platform to include ongoing upgrades and assist in the planning and application of the system, as well as staff education to assure maximum utilization of the system aimed at cost effective and quality services. Assists in the development of new programs and project coordination relevant to data collection for productivity outcomes, referral tracking and benchmarking.

Requirements

High School or GED Equivalent
Must be able to work the hours specified.
Visual acuity adequate to perform position duties.
Ability to communicate effectively with others.
Ability to hear, understand and distinguish speech and other sounds.

Nice To Haves

Certificate from college or technical school
3-6 months experience and/or training

Responsibilities

Serves as primary intake person for incoming requests for multiple sites and appropriately screens incoming referrals and responds in priority levels as set forth by the Access Services Manager.
Registers the patient in the computer system utilizing multiple resources to gather information.
Forwards multi-discipline orders to appropriate sites and completes any other necessary steps to facilitate a timely hand-off.
Completes insurance eligibility and benefit verification, gathers medical necessity documentation, and negotiates pre-authorization as necessary.
Maintains current knowledge base of all payer’s unique rules/regulations, coverage criteria, payer contracts and in-network providers.
Reviews documentation and determines medical necessity coverage per specific payer guidelines and completes Advance Beneficiary Notices (ABN)/waivers when required.
Maintains an up-to-date knowledge of products and services and coverage area.
Utilizes workflow software to track all orders for the purpose of performance productivity, responsiveness, and quality standards and productively participates in continuous quality improvement efforts to streamline workflows, so as to maximize effectiveness and efficiency.
Ensures compliance with state, federal, and accreditation regulatory requirements.
Achieves and maintains a thorough knowledge base of the platform to include ongoing upgrades and assist in the planning and application of the system, as well as staff education to assure maximum utilization of the system aimed at cost effective and quality services.
Assists in the development of new programs and project coordination relevant to data collection for productivity outcomes, referral tracking and benchmarking.