Intake Coordinator

The intake coordinator reviews and approves routine referrals and pre-certifications submitted while following established guidelines for our Blue Cross HMO.
WHAT YOU’LL BE DOING
Initiating pre-review screening on complex referrals and/or pre-certifications and submitting to the Clinical Services Department for review and finalization. Screens potential denials and submits to the Clinical Services Department.
Providing clerical support with computer entry, in-coming and out-going phone calls.
Entering of referral and pre-certifications complying with multiple sets of protocols which are built in the application.
Maintaining and managing strict confidentiality of all information, whether received directly or indirectly as it relates to health care services.
Entering referrals and precertification’s into software program accurately using ICD-10 and CPT coding as well as follow necessary guides to maintain compliance with delegation and state requirements.
Answering phone calls as well as making phone calls.
Accurately and timely review of referral and pre-certifications authorizations.
Assisting physician offices and providers with referral and precertification questions.
Working with Provider Relations and Claims staff to clarify or rectify discrepancies between referrals, precertification’s and claims.
Assisting the Clinical Services Department nursing staff in the development and maintenance of internal referral manuals.
Adhering to all audit procedures.
Performing other duties as assigned.
WHAT YOU'LL NEED FOR SUCCESS
Prior experience in a healthcare setting.
Strong knowledge of HMO
Knowledge of Excel basic function and PDF Converter and/or Adobe Pro
Must be organized and task oriented
Strong time management skills
Ability to work independently
WOULD LOVE FOR YOU TO HAVE
Understanding of medical coding (CPT and ICD-9) Advanced degrees, certifications, or additional experience that could enhance performance.

Employment type
Full-time

Work arrangement
Yes