Entry Level Claims Intake Specialist Jobs (NOW HIRING)

Description of Responsibilities

The Intake Specialist is responsible for the coordination of patient services with the nursing, delivery, and pharmacy departments. Responsible for facilitating the timely evaluation and acceptance of patients referred for service to meet the needs of the patient and customers as requested. Assists the entire intake process from taking referrals and verifying insurance to obtaining documentation and ensuring a smooth transition to the Reimbursement team.

Responsibilities of the Intake Specialist include the following:

1. Report any misconduct, suspicious or unethical activities to the Compliance Officer.

2. Responsible for assisting with referral coordination activity between Sales, Hospital Case

Managers/Physicians and Operations. Ensures all benefits and documentation verification is obtained and accurate to minimize payor and reimbursement issues that could result in claims denials or write offs.

3. Ensure timely and accurate verification of insurance during the initial onboarding process and insure eligibility and authorization status of insured prior to service being provided.

4. Ensures compliance with local and federal regulations, accreditation standards and corporate policies to drive effectiveness and consistency in operations.

5. Model behaviors that demonstrate and support company culture, values, and mission statement daily.

6. Observes legal and ethical guidelines for safeguarding the confidentiality of patient and proprietary company data.

7. Monitors adherence to Policies and Procedures, auditing, as necessary. Ensure Intake department is using appropriate forms, obtaining all proper and complete insurance verifications, and obtaining all authorizations.

8. Ensures the appropriate notification of patients regarding their financial responsibility, benefit coverage and payor authorization for services to be provided.

9. Participate in in-service education programs provided by the pharmacy.

10. Completes all required projects and reports in a timely fashion on a daily, weekly, or monthly basis per the direction of the leadership.

11. Complete special projects as assigned by Leadership within established timeframes.

12. Perform other related duties as assigned by supervisor.

Intake Department Responsibilities:

1. Communicate with patients to obtain information required to process prescriptions, refills, access benefits and apply charges against co-pay cards

2. Investigate and verify benefits for pharmacy and medical third-party claims for assigned cases

3. Obtain prior authorizations; initiate requests, track progress, and expedite responses from insurance carriers and other payers, and maintain contact with customers to keep them continuously informed

4. Review for accuracy of prescribed treatment regimen prior to submission of authorization

5. Facilitate appeals process between the patient, physician, and insurance company; compose clinical appeals letters based off of specific denial reason and patient's clinical presentation and coordinate

appointment of representative document

6. Complete status check with insurance company regarding receipt/outcome of prior authorization and appeal; obtain approval information and activates copay cards based off eligibility and specific drug prescribed

7. Track, report and escalate service issues arising from requests for authorizations, financial assistance or other issues that delay service

8. Notify patients when their prescription has been transferred and follow up with specialty pharmacy to confirm the prescription was received (in some jurisdictions)

9. Coordinate verbal transfer by a pharmacist if specialty pharmacy has no record of prescription (in some jurisdictions); confirm with patient that prescription was received from alternate specialty pharmacy.

10. Complete a series of assessments mandated by either manufacturer contracts or operations and facilitate patient enrollment with manufacturer Hubs when required.

11. Document case activity, communications, and correspondence in computer system to ensure completeness and accuracy of patient contact records

12. Ensure that work activities are conducted in compliance with regulatory requirements and the organizations defined standards and procedures, and in a manner that provides the best available level of service and quality.

13. Perform or assist with any operations, as required to maintain workflow and to meet business needs

14. Must be able to perform the essential job functions of this position with or without reasonable accommodation.

15. Participate in any variety of meetings and work groups to integrate activities, communicate issues, obtain approvals, resolve problems, and maintain specified level of knowledge pertaining to new developments, requirements, and policies.

16. Report any misconduct, suspicious or unethical activities to the Compliance Officer

17. Participate in surveys conducted by authorized inspection agencies.

18. Participate in the pharmacy's Performance Improvement program as requested by the Performance

Improvement Coordinator

19. Participate in pharmacy committees when requested.

Minimum Qualifications:

1. Minimum 3 years of experience in supervision of staff with responsibility for hiring, monitoring productivity, writing performance evaluations, and disciplinary action. Minimum 6 years of experience in intake/admissions.

2. Bachelor's degree in Healthcare Administration or Business-related field, or 6 years' experience in Intake preferred.

3. At least 2 years of experience applying knowledge of Medicare, Medicaid, and Managed Care reimbursement guidelines.

4. Experience in diagnosing, isolating, and resolving complex issues and recommending and implementing strategies to resolve problems.

5. Experience collaborating with internal resources to develop strategies that meet department goals within budget and established timelines.

6. Intermediate level skill in Microsoft Office.

Physical Requirements

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions in this job description:

1. The employee is regularly required to stand, walk, and sit, as well as talk and hear.

2. The employee is required to use hands to operate vehicles and office equipment.

3. The employee must occasionally lift and/or move up to 30 pounds.

4. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, and the ability to adjust focus.

Salary Description

$30 - $35