Intake Specialist

Position Description

This position is responsible to receive and process authorization requests and/or admission notifications from providers/physicians, case managers, vendors and facilities. Provide live telephonic access for providers and internal customers. Perform data entry in support of the review activities of each business unit in the department.

·Answer incoming department calls promptly to assure uninterrupted telephone access for providers and internal customers during regular business hours.

·Monitor and retrieve incoming admission notifications, service requests and other customer inquiries from voicemails, faxes, and mail within established parameters.

·Identify urgent/expedited requests, and provide timely notification to Utilization Review Team.

·Receive and report QIO appeal notifications from KEPRO and report to Utilization Review Team.

·Screen, triage and distribute calls or requests for information to the appropriate team, department or organizational contact.

·Call providers as necessary to obtain information required to initiate reviews, educate on the authorization process and respond to questions or inquiries.

·Enter member admission notification data, and authorization requests. Assign to UR Specialist reviewer following department protocol.

·Perform timely and accurate entry of data within established turnaround times.

·Data entry of Elderly Waiver Approvals. Communication with MSHO/MSC+ care coordinator to include member and provider approval notifications.

·Document provider interactions using established department standards.

·Understand, implement and support the Evidence of Coverage (EOC), Certificate of Coverage (COC), organizational policies, department procedures and protocols; published authorization grids, medical policies, review criteria, review standards and regulatory requirements relative to the intake process.

·Proficient use of computer systems required to perform assigned duties.