Non-Clinical Intake

Community Health Network of Connecticut•Wallingford, CT

9d•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. Primary 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. Essential Functions: 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.

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

Triaging all incoming calls into the Utilization Management Unit
Entering referrals into system
Requesting all clinical information
Forwarding any referral requiring medical necessity determination to clinical staff
Provides support for claim related provider appeals
Reviews all referrals for completeness
Verifies eligibility
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