Health Insurance Intake Specialist - Utilization Management, Southwestern Health Resources (SWHR)
Company: Southwestern Health Resources CIN
Location: Pittston
Posted on: January 27, 2023
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Job Description:
Health Insurance Intake Specialist - Utilization Management
Utilization Management is looking for top skilled Health Insurance
Intake Specialist. Is that you?Work location: Southwestern Health
Resources Headquarters, 1601/1603 Lyndon B. Johnson Freeway,
Farmers Branch, TX 75234. Work environment: Utilization Management
Department. Please note: The Health Insurance Intake Specialist
will be an employee of Southwestern Health Resources (SWHR). SWHR
is a clinically integrated network formed by Texas Health Resources
(THR) and University of Texas Southwestern Medical Center (UTSW).
Work hours: Full Time; 40 hours per week. Tuesday - Friday, 9:00am
- 6:00pm. Saturday, 6:00am - 2:30pm. This is a Hybrid position,
requiring occasional onsite workdays based on department business
needs. In-person attendance required at department meetings,
trainings and/or other department authorized activities, at the
above-mentioned address or other locations as directed by the
department management. Organization Highlights Southwestern Health
Resources (SWHR) is a patient-centered, clinically integrated
network of 29 hospital locations and more than 6,900 physicians and
clinicians caring for more than 730,000 patients across 16 counties
in North Texas. Blending the strengths of Texas Health Resources
and the University of Texas Southwestern Medical Center, SWHR
offers an unmatched ability to connect individuals with a full
spectrum of nationally preeminent, clinical care. SWHR is the
parent of Care N' Care Insurance Co., a leading regional Medicare
Advantage health plan providing care to over 12,000 members. At
SWHR, we believe healthcare can be more integrated, accessible and
affordable for all. Our purpose: to build a better way to care,
together. Our promise: to simplify and empower care, for good.
Here's What You Need Education High School Diploma or equivalent
required. Associate's Degree preferred. Experience Require 2 years
of Medical Referrals and Preauthorization experience in a
Healthcare setting. Require 2 years' experience in a high
production environment in a Healthcare setting. Skills & Abilities
High level experience in data entry with accuracy. Excellent typing
skills. Excellent phone etiquette. Ability to provide "customer
service focus" Work requires ability to communicate effectively
with various levels of internal and external contacts. Work
requires ability to work with confidential information on daily
basis. Interpersonal and teamwork skills to contribute to
objectives of organization. Adaptability/flexibility to react
positively to changes in work environment. Initiative to improve
productivity and quality of work. Knowledge of specific regulatory,
Managed Care requirements. Must be proficient in various word
processing, spreadsheet, graphics, and database programs including
Microsoft Word, Excel, Access, PowerPoint, Outlook, etc. Working
knowledge and ability to apply professional standards of practice
in work environment. What You Will Do Position Responsibilities The
Health Insurance Intake Specialist will be responsible for
processing precertification and referral requests for health care
services. The duties of this position will include but are not
limited to verifying plan coverage/PCP, securing patient
demographics, referring physician, current health status including
clinical history/physical information, status of admission or
discharge and requested procedures. This position will be
responsible for reviewing, triaging, and processing
precertification and referrals. The Intake Specialist will be
responsible for accuracy and completeness of precertification and
referral information within the database in accordance to all
compliance and regulatory requirements. This role is responsible
for communicating authorization information to appropriate
individuals within the specified timeframe, inclusive of internal
and external clients. The Intake Specialist will respond to
inquiries and provide additional information to physicians as
needed. They will make outreach calls to providers, facilities,
office staff, and/or Case Managers to obtain any clinical
rationale, or status updates for UM/UE requests. The Intake
Specialist will review requests for appropriate network utilization
and will re-direct cases as needed. The Intake Specialist will be
responsible for handling volume of inbound and outbound calling
from and to providers and members as needed. This position is
responsible for providing excellent customer service in handling
these calls. They will effectively communicate results to executive
management, internal and external clients, and maintain a positive
attitude while working in a dynamic, fast-paced environment. The
Intake Specialist will adhere to all regulatory and delegation
requirements, including turn-around time. Position Functions
Performs high level of data entry. Follows standard operating
procedures for updating authorizations, including precertification
and IP notifications in Care Managements software. Meets any intake
production or QA metrics. Responsible for processing, entering,
triaging and routing all precertification and referral requests.
Ensures the overall data integrity of documents received and
entered into computer system. Responsible for following
non-clinical algorithms, network tier structure/exceptions, and
precertification and referral requirements by health plan for
initial organization determinations and referrals. Responsible for
following all compliance and regulatory requirements for
turn-around time, notification to provider/member, and
accuracy/completeness. Supports UM/UE Clinical staff in obtaining
clinical information and status of requests. Supports CM Clinical
staff in processing referrals to the care management program.
Responsible for supporting any assigned special projects pertaining
to UM/UE functions, customer service, and care management.
Responsible for outreach to providers to obtain necessary
information to process precertification and referral requests.
Consistently meets performance standards of production, accuracy,
completeness and quality. Handles volume of inbound and outbound
phone calls with excellent customer service as needed. Updates Care
Management appropriate wrap-up codes, break/lunch codes and any
other codes for accurate and complete reporting when handling
volume of inbound phone calls. Communicates actively and routinely
with management team, and staff in handling client services,
issues, escalated referral and preauthorization questions. Manages
fax server, online requests and phone inquiries and processes
requests from each. Secures patient demographics, verify benefits,
and requests and enters clinical history as needed. Uses
interpersonal/communication strategies with individuals to achieve:
desirable/acceptable outcomes/responses, perceptions of
satisfaction or acceptance of those involved. Perform procedures
required by the assignment: (a) safely, without causing harm, (b)
effectively, achieving the intended outcome/result, (c)
efficiently, using the fewest possible resources, (d) legally,
within the scope of practice/policy. Establishes and/or revises
priorities based on: (a) urgency of the patient or organization's
needs, (b) resource availability, (c) predetermined schedules, (d)
other departments/personnel expectations. Competes all compliance,
regulatory and process training within the specified timeline.
Demonstrates a high level of critical thinking and detail
orientation. Complies with established procedures and personnel
policies. Why Southwestern Health Resources As a Southwestern
Health Resources employee, you'll enjoy, comprehensive benefits,
including a 401(k) with match; paid time off; competitive health
insurance choices; healthcare and dependent care spending account
options; wellness programs to keep you and your family healthy;
tuition reimbursement; a student loan repayment program; and more.
Additional perks of being an SWHR employee: Gain a sense of
accomplishment by contributing to a teamwork environment.
Positively impact patients' quality of life. Receive excellent
mentorship, comprehensive training and dedicated clinical and
administrative leadership resources. Enjoy opportunities for
growth. Explore Southwestern Health Resources Careers for more
information and to search all career opportunities. Our Recruitment
team invites you to contact us with any questions at
Keywords: Southwestern Health Resources CIN, Scranton , Health Insurance Intake Specialist - Utilization Management, Southwestern Health Resources (SWHR), Executive , Pittston, Pennsylvania
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