Non-Clinical Intake

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

4h•$37,440 - $39,520

About The Position

Community Health Network of Connecticut, Inc. (CHNCT) is currently seeking a Non-Clinical Intake Representative. This role is responsible for triaging incoming calls, entering referrals, requesting clinical information, and forwarding referrals requiring medical necessity determination to clinical staff. The position also provides support for claim-related provider appeals. The Non-Clinical Intake Representative will respond to telephonic requests from providers for authorization and benefit coverage for CHNCT members across all lines of business, approving services based on the benefit package. They will perform data entry for various services, interact with providers and vendors to gather necessary medical information, and identify service requests for non-participating providers or those outside member benefit packages for referral to clinical staff. The company is dedicated to a workplace where everyone feels valued, respected, and empowered, embracing diverse perspectives and backgrounds to foster an innovative and collaborative environment. They are also committed to an inclusive and accessible interview process.

Requirements

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

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.
Perform other duties as assigned.
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.