Non-Clinical Intake

Community Health Network of Connecticut•Wallingford, CT

18h

About The Position

Community Health Network of Connecticut, Inc. (CHNCT) is currently seeking a Non-Clinical Intake Representative. This position will be filled through selected staffing agencies. The role is responsible for triaging incoming calls, entering referrals, requesting clinical information, and forwarding referrals requiring medical necessity determination to clinical staff. It also provides support for claim-related provider appeals.

Requirements

Secondary schooling
High school diploma or GED
1 to 3 years' related experience
Claims processing background preferred
Excellent interpersonal/telephone communication skills
Knowledge of medical terminology, ICD9 and CPT 4 coding
Strong word processing and data entry skills
Ability to handle several tasks concurrently

Responsibilities

Triage all incoming calls into the Utilization Management Unit.
Enter referrals into the system.
Request all clinical information.
Forward referrals requiring medical necessity determination to clinical staff.
Provide support for claim-related provider appeals.
Review all referrals for completeness, verify eligibility, and verify that the provider is in-network.
Assist with the entry of new hospital admissions.
Maintain knowledge of covered benefits of Medicaid programs.
Identify and refer for coordination of benefits (COB) and third-party liability (TPL) as appropriate.
Maintain confidentiality of member-specific records.
Act as preceptor to new staff.
Respond to telephonic requests by providers for authorization and benefit coverage for CHNCT members for all lines of business.
Approve services based on benefit package.
Perform data entry for specialty visits, rehabilitation, DME, etc.
Interact with providers and vendors to collect necessary medical information and office notes needed to support clinical staff in decision making.
Identify service requests for non-par providers and services outside of member benefit packages and refer to clinical staff.