The Intake Coordinator staff member is responsible for answering incoming telephone calls to the Medical Management Services Area and entering all information relating to Medical Management Services into the EPIC/Tapestry Claims/Referral System.
This staff person is also responsible for processing referrals for members of non-capitated healthplans according to the Medical Management Services established procedure.
Essential Duties and Responsibilities:
Process referrals as defined by Medical Management Services (MMS) Policy and Procedures and specific Health Plan guidelines.
Accept calls from, and initiate calls to provider offices regarding referral submissions and status.
Assist physician office staff in resolving identified issues.
Treat all callers with respect.
Perform data entry of referrals, pre-certifications and other information pertaining to the
Medical Management Services department functions.
Monitor for incomplete/incorrect information on submitted documents and insure that problems are brought to the attention of the appropriate person.
Document all pertinent information obtained through discussion with providers, patients,
family members and other health care professionals.
Use established MMS/Claims policies and procedures to determine if, based upon present information, services identified by claims have been authorized.
Enter appropriate documentation in Tapestry.
Communicate authorizations to Claims department staff within prescribed timeframes.
Develop and maintain good relations with Managed Care Operations staff, physicians, clinic staff, patients and family members.
Act as a resource for Managed Care Operations staff, physicians, clinic staff, patients and family members.
Assist the Utilization Management Coordinators with referral processes as needed.
Report problems to the Referral Process Supervisor and work with Supervisor on a corrective action plan.
Develop and implement details of new processes upon the request of the Supervisor.
Maintain confidentiality of all information as stipulated in the confidentiality policy.
Perform other projects and duties as related to department objectives.
Must be able to get along with others, to be a team player, to accept constructive criticism from supervisor and be able to follow work rules.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
Organizational skills are essential to prioritize daily work and maintain documents for use by the Medical Management Services staff. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.
Education and/or Experience:
High School degree. Data entry skills of 30 wpm required. Familiarity with Medical Terminology and general health plan referral process a plus.
Ability to work hours as prescribed by the MMS Department. Most duties are performed at the desk on the computer, with frequent trips to printer, fax and copy machines.
Ability to handle large volume of calls and cases in a professional manner. Ability to work with variety of personalities both on the phone and within the office.
The above statements in this job description are intended to describe the nature and level of work performed by employees assigned to this job.
They are not intended to be an exhaustive list of all responsibilities, duties and skills required of personnel so classified.