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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