Job Description

Job Description

Job Description

Community Health Network of Connecticut, Inc. (CHNCT) is currently seeking a Non-Clinical Intake Representative.

Primary Responsibilities:

• Responsible for triaging all incoming calls into the Utilization Management Unit, entering authorization requests into system, requesting all clinical information and forwarding any request requiring medical necessity determination to clinical staff.
• Provides support for authorization/claim related provider appeals.

Tasks Performed:

• Reviews authorization requests for completeness, verifies eligibility and verifies that provider is in network.
• Assists with entry of hospital admissions and goods or services that require prior authorization.
• Maintains knowledge of covered benefits of Medicaid programs.
• Identifies and refers for coordination of benefits (COB) and third party liability (TPL) as appropriate.
• Maintains confidentiality of member specific records.
• Acts as preceptor to new staff.
• Performs other duties as assigned.

Essential Functions:

• Responds to telephonic requests by providers for authorization and benefit coverage for CHNCT members for all lines of business.
• Triages calls related to entries in the authorization portal.
• Performs data entry for specialty visits, rehabilitation, durable medical equipment (DME), etc.
• Approves services based on benefit package.
• Processes modification requests for existing authorizations.
• Interacts with providers and vendors to collect necessary medical information and office notes needed to support clinical staff in decision making.
• Identifies service requests for non-par providers and services outside of member benefit packages and refers to clinical staff.

Desired Education: Secondary schooling

Desired Degree: High school diploma or GED

Desired Job Experience: 1 to 3 years' related experience

Other Qualifications: Claims processing background preferred. Excellent interpersonal/telephone communication skills. Knowledge of medical terminology, ICD10 and CPT 4 coding. Strong word processing and data entry skills. Ability to handle several tasks concurrently.

We are dedicated to having a workplace where everyone feels valued, respected, and empowered to succeed. We embrace a wide range of perspectives and backgrounds, ensuring fair treatment and opportunities for all employees. We value of our team’s rich array of experiences and viewpoints, which contribute to our innovative and collaborative environment.

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