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MGA Intake Specialist

Company: MGA Homecare
Location: Manchaca
Posted on: May 14, 2022

Job Description:

Job Description

  • Identify, sort, and route a high volume of requests received via fax, online, mail, or phone inquiries and process requests from each.
  • Perform high level of data entry.
  • Demonstrate a high level of critical thinking and detail orientation.
  • Review all referral and preauthorization requests for accuracy and completeness.
  • Secure patient demographics, verify benefits, and request and enter clinical history as needed.
  • Ensure the overall data integrity of documents received and entered into computer system.
  • Provides timely oral and/or written notification of determination to provider and member
  • Thoroughly documents all case notes in Care Management software
  • Assist in administrative and data entry function as needed pertaining to UM functions, customer service and care management.
  • Ensure the overall data integrity of documents received and entered into computer system
  • Responsible for following non-clinical algorithms, network tier structure/exceptions and preauthorization requirement by health plan for initial preauthorization of services.
  • Responsible for following all compliance and regulatory requirements for turn-around time, notification to provider/member, and accuracy/completeness
  • Responsible for processing all Out of Preferred Network and Out of Network (OOPN / OON) requests, inclusive of the redirection process and preparation of denials.
  • Supports UM Clinical staff in obtaining clinical information, status of requests, and status of admission/discharge.
  • Handle a high level of inbound and outbound phone calls with excellent customer service
  • Be responsible for meeting telephone system metrics set by the health plan to include length of call, length of answer time and number of calls taken within a specific period.
  • Responsible for supporting any assigned special projects pertaining to UM functions, customer service, and care management.
  • Consistently meets performance standards of production, accuracy, completeness and quality.
  • Communicate actively and routinely with management team, and staff in handling client services, issues, escalated referral and preauthorization questions.
  • Use interpersonal/communication strategies with individuals to achieve: (a) desirable/acceptable outcomes/responses (b) perceptions of satisfaction or acceptance of those involved.
  • Comply with established Silverback procedures and personnel policies.
  • 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
  • Establish and/or revise priorities based on: (a) urgency of the patient or organizations need (b) resource availability (c) predetermined schedules (d) other departments/personnel expectations.Qualifications
    • High School Education required- Associates Degree preferred
    • Strong verbal and written communication skills (Additional languages preferred)
    • 2+ year experience in a clinical environment preferred
    • Requires in depth knowledge of insurance benefits
    • Exceptional Customer Service
    • Proficient use of standard computer programs for data entry and data organization
    • Bilingual (English & Spanish)Additional InformationCompensation/Benefits:
      • Competitive wages
      • Weekly pay
      • Medical, Dental & Vision Coverage Available 1st of the month following 30 days of employment
      • Health Savings Accounts (HSA)
      • Flexible Spending Accounts (FSA)
      • Voluntary Short Term & Long Term Disability
      • Employee Assistance Program (EAP)
      • 401(k) retirement plan
      • Paid Time Off (PTO)
      • 7 Company Paid Holidays
      • 100% Company Paid Life Insurance
      • Voluntary Life Insurance
      • Accident, Hospital, and Critical Illness Insurance
      • Identity Theft Protection Plan
      • Discounted Legal Care PlanPandoLogic. Keywords: Health Service Coordinator, Location: Manchaca, TX - 78652 , PL: 531386218

Keywords: MGA Homecare, Austin , MGA Intake Specialist, Other , Manchaca, Texas

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