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POSITION TITLE: Non-Clinical Intake Coordinator II – Non-Certified
About the Role
Under the direction of the Administrative Director of Health Services and the Health Services Manager, the Non-Clinical Intake Coordinator II will support the Clinical Intake staff in processing Health Plan referrals for medical services, durable medical equipment, and specialty care. This role will provide administrative support to the Utilization Management (UM) Department in the authorization process to ensure accurate service determinations, coverage limitations, and timely communication. This position acts as a liaison between providers, members, and the UM process and provides administrative support to the UM Department within a licensed Health Maintenance Organization (HMO).
Essential Duties and Responsibilities
Screen calls from providers and members regarding the UM process.
Obtain referral information from providers and members to facilitate the authorization process.
Serve as a liaison between members, community providers, and UM clinical staff.
Assign diagnostic and procedural codes using ICD-9 and CPT coding systems for service requests; consult with Clinical Intake staff for clinical expertise when necessary.
Review referral types using established criteria for pre-authorization of payment; route requests to Clinical Intake Coordinators for approval or auto-authorizations.
Interpret benefits and coordinate care for medically necessary services not covered under the plan (e.g., CCS, Long Term Care, and State Waiver Programs).
Obtain additional medical information for clinical staff to prepare authorizations for review.
Coordinate Health Plan services between the UM Department and Member Services and Provider Relations.
Review member history, eligibility, and previous referral authorizations.
Monitor, track, and process provider service appeals.
Ensure accurate data entry of authorizations into the system.
Act as a resource for Non-Clinical Intake Coordinator Level I staff.
Adhere to the company’s Code of Ethics and Business Conduct and all policies, including confidentiality, attendance, safety/security, equipment usage, and appearance.
Perform other job-related duties as assigned.
Follow all policies and procedures related to employment and job responsibilities.
Employment Standards
Education and Experience:
High School Diploma from an accredited school or equivalent.
Associates degree preferred.
Minimum of two (2) years of experience in a managed care setting.
Typing certificate for 30 wpm within one year of issuance.
At least two years of data entry and computer experience.
Proficiency in ICD-9, ICD-10, and CPT coding procedures.
Experience with medical terminology.
Knowledge of:
Medicaid benefits
Microsoft Office products
Commitment to Diversity: As an equal opportunity employer committed to meeting the needs of a multi-generational and multicultural workforce, Key Staffing recognizes that a diverse staff, reflective of our community, is an integral and welcome part of a successful and ethical business. We hire local talent at all levels regardless of race, color, religion, age, national origin, gender, gender identity, sexual orientation, or disability and actively foster inclusion in all forms both within our company and across interactions with clients, candidates, and partners.
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