Non-Clinical Intake Coordinator III Certified - Temporary

KHS•Bakersfield, CA

About The Position

We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will help us potentially place you in a position that meets your objectives and those of the organization. Qualified applicants are considered for positions without regard to race, color, religion, sex (including pregnancy, childbirth and breastfeeding, or any related medical conditions), national origin, ancestry, age, marital or veteran status, sexual orientation, gender identity, genetic information, gender expression, military status, or the presence of a non-job related medical condition or disability (mental or physical). This is a full-time temporary position. If selected, onboarding will be completed through a staffing agency About us Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.

Requirements

High School Diploma from an accredited school or equivalent.
Medical Assistant associate’s degree/diploma or Medical Assistant Certificate or Certified Nurse Assistant (CNA) required.
Minimum of two (2) years of experience in a managed care setting.
Data entry and computer experience of at least two years.
Proficient in ICD-9, ICD-10, and CPT coding procedures.
Experience with medical terminology.
Typing certificate for 30 wpm.

Responsibilities

Screen calls from KHS providers and KHS members regarding the KHS UM process.
Obtain referral information from providers and members to implement and facilitate the authorization process.
Act as liaison to KHS members, community providers, and employees to the UM clinical staff.
Assigns diagnostic and procedural codes using ICD10, and CPT coding classification system for service requests. Requests input from the Clinical Intake Staff when needing direction or clinical expertise.
Reviews specified referral types using established criteria for purposes of pre-authorization of payment, when indicated routes requests to Clinical Intake Coordinators for approval or auto-authorizations.
Benefits interpretation to include coordination of care for medically necessary services that are not covered under the KHS Plan (e.g. CCS, and State Waiver Programs.)
Obtains additional medical information for clinical staff for preparation of authorizations for Clinical Intake Coordinator review.
Coordination of Health Plan services between KHS UM Department and KHS Member Services and Provider Relations.
Reviews member history and eligibility and previous referral authorizations.
Monitors, tracks, and processes provider service appeals.
Ensures accurate data entry of authorizations in the QNXT system.
Acts as a resource to Non-Clinical Intake Coordinator Level I and Non-Clinical Intake Coordinator Level II staff.
Adheres to KHS’s Code of Ethics and Business Conduct and all company policies, e.g., confidentiality, attendance, safety/security, use of equipment and technology, appearance and demeanor.
Performs other job-related duties as assigned.
Adheres to all company policies and procedures relative to employment and job responsibilities.