JOB SUMMARY
Position is responsible for gathering demographics and initial intake, health benefit eligibility screening and information services to TWCCH clients. Responsible for screening all Mental Health and COE clients to determine health benefits, public benefits eligibility and insurance verifications. The Intake and Health Insurance Specialist will seek to maximize benefits available in private and public programs. Quality patient care and patient satisfaction is the primary goal.
Required Skills
JOB DUTIES AND ESSENTIAL FUNCTIONS
- Answer calls and questions inquiring about services
- Screens individuals on the phone in order to match to the appropriate department and guide them through the intake process into that department
- Verifies client insurance benefits and eligibility all demographic and benefits information through EVS Promises/Navinet
- Conducts intake interviews with new or re-admitted clients to gather necessary administrative information; computes and verifies family income and size and places client appropriately on sliding scale if requested, and explains billing policies and fees to client
- Maintains current knowledge regarding third-party and first-party payment procedures and regulations as well as preferred provider agreements
- Refers clients with possible Medicaid eligibility criteria and/or unresolved account questions
- Tracks enrollment status of clients assisted and provides support as appropriate to complete enrollment and/or document barriers to enrollment, if any
- Provides excellent internal/external customer services via telephone, to assist patients/ clients with their eligibility and enrollment needs, and staff with questions or concerns regarding health coverage programs processes and requirements. Keeps current with trends and developments related to essential job competencies
- Protects confidentiality of patients and clients at all times
- Follows policies and procedures for timely and complete documentation in the Electronic Medical Record (EMR) Medent
- Attends regular team meetings Attends monthly staff meetings and all mandatory organization activities Projects positive, flexible attitude in attempting to meet patient’s scheduling needs
- Keeps accurate, up-to-date files of all referrals received in the department
- Performs reception functions and assures that the telephones are answered, and patients/visitors are greeted in a timely, courteous and professional manner
- Performs registration functions and assures timely, efficient and customer-friendly registration system
- Processes insurance eligibility and benefits verification for all patients
- Processes insurance pre-authorizations for all patients. Assists in resolving account denials
- Keeps prior authorization Work Queue list up-to-date and follows-up on aging requests
- Works with department staff to resolve pre-billing edits to ensure timely filing and clean-claim requirements
- Completes all prior authorizations for medications
- Completes Behavioral Health managed care patient registration forms. Performs other duties assigned
Required Experience
QUALIFICATIONS
• Associate’s Degree, Bachelor’s Degree Preferred
• Previous front-desk experience in a medical/ Behavioral Health setting desirable
• Knowledge working with managed care organizations as well as Uninsured and underserved populations
• Critical thinking with the ability to effectively problem solve (e.g. able to determine if a patient issue requires immediate provider attention if there are significant changes to the patient history or other clinical issues that are presented)
• Strong customer service skills and strong multi-tasking skills
• Organizational and time management skills to effectively juggle multiple priorities, time constraints and large volumes of work