Intake Representative

COMAGINE HEALTH•Washington, NV

6d•Remote

About The Position

In this remote Intake Representative role, you will work in a fully electronic environment, reviewing incoming requests for utilization review and other medical management services, verifying that documentation is complete and accurate, and ensuring cases are ready for clinical review. Your work involves using an electronic medical record system and other platforms to validate eligibility, confirm claim and provider information, compare documentation across sources, and follow up as needed to gather missing details. You will balance queue-based work with inbound calls, managing priorities independently throughout the day. We’re looking for someone with a strong healthcare support background, including comfort with medical terminology, documentation review, and validating detailed information for accuracy and completeness. If you are naturally curious, able to work independently, and bring a high level of attention to detail and consistency in your work, we encourage you to apply. You must reside in the Pacific Time Zone and be available to work Monday through Friday, 8:00 AM to 5:00 PM, PST.

Requirements

High school diploma or equivalent or equivalent combination of education and/or work experience in related field may be substituted.
2 years of related work experience or customer service experience.
1 year of work experience in healthcare.
Intermediate understanding of medical terminology.
Intermediate Microsoft Office Suite proficiency.
Demonstrated proficiency with medical terminology.
Participates in orientation and training of other Intake staff.

Nice To Haves

Post-secondary education or certification in a related field preferred.
2 years of work experience in healthcare; nursing assistant or medical assistant experience.

Responsibilities

Validate the request submitted via the Comagine Health Provider Portal for accuracy and completeness.
Screen cases for required medical information based on type of request, determining if information is sufficient for clinical review.
Obtain clinical information from the client systems when indicated or contact provider to obtain information required for review.
Determine based on training when a scripted review is indicated based on contract requirements.
Process requests after physician review, evaluating language and working with physician reviewers, clinical reviewers, or managers to ensure language and determination information is complete before sending letters to providers.
Respond to inbound telephone requests with clear documentation in the care management system of calls.
Enter case information from original source documentation or validate information entered by providers in the portal.
Make courtesy calls with case reference numbers.
Provide notification of completed review and additional information needed, when applicable.
Contribute to orientation and training of other non-clinical employees.
As requested, create templates for complex reviews, perform internal quality reviews, and/or participate in provider outreach activities.
May perform scripted clinical reviews and refer reviews requiring further action to clinical review staff.
After physician review, notify providers of decertification or potential denial of services by phone or in writing as required by contract.
Complete case after physician review, returning to clinician or sending to client based on procedure.
Arrange ancillary authorization requests such as transportation and accommodation.
Obtain customer consent for care management services to be performed.
Correspond with facilities, providers, and others.
Coordinate non-clinical functions and intervention, as directed.
Perform supervised closure of cases upon completion of review by a clinical reviewer, as directed.