AustinRecruiter Since 2001
the smart solution for Austin jobs

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

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category

Log In or Create An Account

Get the latest Texas jobs by following @recnetTX on Twitter!

Austin RSS job feeds