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