This job listing has expired and the position may no longer be open for hire.
Intake Specialist - Utilization Management - Southwestern Health Resources (SWHR) at Southwestern Health Resources CIN in Pittston, Pennsylvania
Posted in General Business 30+ days ago.
Type: Full-Time
Job Description:
Intake Specialist
Utilization Management
Southwestern Health Resources, a national leader in population health, is looking for a qualified Intake Specialist to join our Utilization Management team.
If you're looking for a rewarding career at a patient-centered organization with work-life balance and comprehensive benefits, we want to hear from you.
Position Highlights
Work location: Southwestern Health Resources, 1603 Lyndon B. Johnson Freeway, Farmers Branch, TX 75234.
Work environment: Utilization Management.
Please note: The 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.
- Monday - Friday; 9:00am - 6:00pm.
- This is a Hybrid position, requiring occasional onsite workdays based on department business needs.
- Require in-person attendance as needed, to department meetings, trainings and/or other department authorized activities, at the above-mentioned address or other locations as directed by the department management.
The SWHR Network includes physicians from University of Texas Southwestern Medical Center and Texas Health Resources, as well as more than 2500 independent community Primary and Specialty Care Physicians. In partnership, our team implements physician-driven, value-based care strategies to coordinate care for more than 700,000 patients, across 16 counties in North Texas, resulting in lower costs and high-quality care.
In 2020, the Centers for Medicare & Medicaid Services (CMS) released the annual financial and quality results. Based on the report, SWHR is one of the nation's leading Next Generation Accountable Care Organizations (ACO), having saved nearly $120 million since joining the program in 2017.
SWHR is the parent organization of Care N' Care Insurance Co., a leading regional Medicare Advantage health plan organization that serves approximately 17,000 patients in North Texas.
Education
- High School Diploma or equivalent required.
- Associate's Degree preferred.
- 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.
- 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.
The 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.
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.
Our Recruitment team invites you to contact us with any questions at recruitment@texashealth.org
More jobs in Pittston, Pennsylvania
|
Southwestern Health Resources CIN |
|
Oldcastle |
|
Oldcastle |