Position Purpose and Description
Reporting to the Case Management Workforce Supervisor, the Intake Coordinator is primarily responsible for handling a case from start to finish
He/she will provide policy benefits and exclusion as well as approve medical consultations and testing and reassure the prompt follow up in close cooperation with the medical team (case managers and medical advisor).
Hybrid role
Expected Outcomes & Actions – Weighting
- CASE COORDINATION (100%)
- Responsible to support the Case Management Service Levels
- Prioritize cases and determines urgency and necessity of case management
- Coordinating service requests for the Corporate Clients
- Work closely with the Customer Service, Managed Care, Account Management and other departments when applicable
- Refer the patient to the most appropriate provider based on cost and quality
- Verify all information obtained in the initial case notification
- Obtain in writing all necessary medical information required by Client to provide coverage confirmation
- Verify treatment meets medical criteria
- Setting an initial reserve, updated reserve and final reserve accurately
- Verify charges are within Usual Customary and Reasonable (UCR)
- Provide Options or alternative care when charges are not within UCR
- Review medical information to determine if further treatments are needed, review medical updates, and validate with the policy wording
- Serve as an advocate to the patient and provide personalized service when request from corporate client
Major Challenges
- Working with multiple systems
- Staying current on systems, processes and products
- Managing fluctuating volumes
- Remaining calm and professional in difficult situations
Major Job Accountabilities
- Accuracy- obtaining required information and entering information accurately
- Quality – opening quality claims according to claim opening guidelines
- Efficiency – managing your work and productivity
- Adherence and Absenteeism – adhering to your work schedule
Success Measures
- Meeting or exceeding your quality targets;
- Meeting or exceeding your productivity targets;
- Meeting or exceeding your adherence targets.
KSA (Knowledge, Skills and Abilities/Attitudes)
- Professional
- Excellent communicate skills
- Excellent customer service skills
- Good computer skills
- Team player
- Reliable
- Ownership
- Attention to detail
- Balanced Decision Making
- Empathetic Outlook
- Flexibility
- Problem solving skills
- Positive attitude
- Stress management skills
- Personal accountability
- Result oriented
- Self-confidence
- Understanding the corporate client culture/expectations
- Multi-tasking
Requirements and Qualifications
- College Diploma;
- One to two years of experience in a customer service-related position;
- Clear and effective communication in both English and Spanish (written and verbal);
- Capacity to work with people in a fast-paced, team-based environment.
- Must exhibit strong communication skills and professionalism.
- Capable and confident in negotiations and problems solving skills.
- Working knowledge of Microsoft Office application and Internet.