Non-Clinical Intake

Community Health Network of Connecticut, Inc.•Wallingford, CT

10d•$0 - $20•Onsite

About The Position

Community Health Network of Connecticut, Inc. (CHNCT) is currently seeking a Non-Clinical Intake Representative. Please note that this is a temporary assignment and will be filled through selected staffing agencies. Please indicate which staffing agency you are working with on your application.

Requirements

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.

Nice To Haves

Claims processing background preferred.

Responsibilities

Responsible for triaging all incoming calls into the Utilization Management Unit, entering referrals into system, requesting all clinical information and forwarding any referral requiring medical necessity determination to clinical staff.
Provides support for claim related provider appeals.
Reviews all referrals for completeness, verifies eligibility and verifies that provider is in network.
Assists with entry of new hospital admissions.
Maintains knowledge of covered benefits of Medicaid programs.
Identifies and refers for coordination of benefits (COB) and third-party liability (TPL) as appropriate.
Maintains confidentiality of member specific records.
Acts as preceptor to new staff.
Performs other duties as assigned.
Responds to telephonic requests by providers for authorization and benefit coverage for CHNCT members for all lines of business.
Approves services based on benefit package.
Performs data entry for specialty visits, rehabilitation, DME, etc.
Interacts with providers and vendors to collect necessary medical information and office notes needed to support clinical staff in decision making.
Identifies service requests for non-par providers and services outside of member benefit packages and refers to clinical staff.