Non Clinical Intake Coordinator III Certified
About The Position
Under direction of the KHS Director of Health Services and the Health Services Manager, the Non-Clinical Intake Coordinator III will support the Clinical Intake staff in the processing of Health Plan referrals for medical services, durable medical equipment, and specialty care. This position will provide the UM Department with administrative support in the implementation of the authorization process to ensure accuracy of service determinations, limitations of Health Plan coverage, and timeliness in the communication and decision-making process. This position will play a key role as provider and member liaison to the KHS UM process. This position will provide administrative support to the Utilization Management Department of KHS, a licensed health maintenance organization (HMO).
Requirements
- High School Diploma from an accredited school or equivalent.
- Medical Assistant associate’s degree/diploma or Medical Assistant Certificate or Certified Nurse Assistant (CNA) required.
- Minimum of two (2) years of experience in a managed care setting.
- Data entry and computer experience of at least two years.
- Proficient in ICD-9, ICD-10, and CPT coding procedures.
- Experience with medical terminology.
- Typing certificate for 30 wpm.
Responsibilities
- Screen calls from KHS providers and KHS members regarding the KHS UM process.
- Obtain referral information from providers and members to implement and facilitate the authorization process.
- Act as liaison to KHS members, community providers, and employees to the UM clinical staff.
- Assigns diagnostic and procedural codes using ICD10, and CPT coding classification system for service requests.
- Requests input from the Clinical Intake Staff when needing direction or clinical expertise
- Reviews specified referral types using established criteria for purposes of pre-authorization of payment, when indicated routes requests to Clinical Intake Coordinators for approval or auto-authorizations.
- Benefits interpretation to include coordination of care for medically necessary services that are not covered under the KHS Plan (e.g. CCS, and State Waiver Programs.)
- Obtains additional medical information for clinical staff for preparation of authorizations for Clinical Intake Coordinator review.
- Coordination of Health Plan services between KHS UM Department and KHS Member Services and Provider Relations.
- Reviews member history and eligibility and previous referral authorizations.
- Monitors, tracks, and processes provider service appeals.
- Ensures accurate data entry of authorizations in the QNXT system.
- Acts as a resource to Non-Clinical Intake Coordinator Level I and Non-Clinical Intake Coordinator Level II staff.
- Adheres to KHS’s Code of Ethics and Business Conduct and all company policies, e.g., confidentiality, attendance, safety/security, use of equipment and technology, appearance and demeanor.
- Performs other job-related duties as assigned.
- Adheres to all company policies and procedures relative to employment and job responsibilities.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
