Intake Coordinator, Utilization Management
Evolent Health- Full Time
- Posted : 3 years ago
TELECOMMUTE LOCATION - REMOTE, US
ABOUT EVOLENT HEALTH
Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving power that brings us to work each day. We believe in embracing new ideas, testing ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.
Are we growing? Absolutely. We have seen about 30% average growth over the last three years. Are we recognized? Definitely. We were named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019 and are proud to be recognized as a leader in driving important Diversity and Inclusion (D&I) efforts: Evolent achieved a 95% score on its first-ever submission to the Human Rights Campaign’s Corporate Equality Index, was named on the Best Companies for Women to Advance List 2020 by Parity.org, and we publish an annual Diversity and Inclusion Annual Report to share our progress on how we’re building an equitable workplace. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.
Responsibilities and DutiesThis position is responsible for providing telephone support, data entry, and routing of cases to the appropriate Utilization Management staff member.
- Answers incoming queue calls to maintain established Average Speed of Answer and abandonment rates
- Enters data into the authorization system for admissions, outpatient procedures, therapies, home health, and DME.
- Promptly records demographic information while meeting quality audit thresholds
- Accurately verifies member eligibility and provider participation prior to routing case to Utilization Management Nurse, noting any discrepancies/problems in notes received form provider.
- Provides provider with case reference number upon completion of data entry and /or nurse approval.
- Performs initial coding of admission and surgical procedures for precertification.
- Chooses appropriate ICD-10-CM and /or CPT-4 procedure code at time intake is completed.
- Maintains a current knowledge base with regards to rules, regulations, policies, and procedures relating to precertification and concurrent review.
- Regularly reviews and monitors compliance with Evolent Health Plan policies and procedures.
- Adheres to state and federal regulations.
- Promptly makes recommendations to ensure compliance with rules, regulations, policies and procedures.
- Assists with developing and updating policies and procedures as needed or requested.
- Prepares medical denial letters for UM staff as requested.
- Responds in an intelligent and comprehensive manner and displays a clear understanding and accurate reflection of Evolent Health goals, objectives, policies, procedures, and priorities.
- Addresses the majority of inquiries independently without unnecessary or recurring contact or excessive dependence on supervisor.
- Discriminates between routine and significantly sensitive matters or those issues for which direct response is inappropriate; promptly apprises immediate supervisor or assigned designee and or refers the issue to the appropriate individual.
- Addresses request promptly and courteously, honors commitments and displays persistence obtaining necessary information to address issues and problems.
Perform other duties and projects as assigned.
Key Competencies/Success Factors:
- Lives the values: Integrity, Community, Collaboration and Stewardship, as defined in the performance appraisal.
- Excellent written and verbal communication skills.
- Strong organizational skills.
- Ability to adapt to fluctuating situations and perform work of a detailed nature, avoiding errors.
- Proficient experience using Outlook, Word, Excel and PowerPoint in a Windows operating system.
The Experience You’ll Need (Required):
- High School Diploma required; Associate’s degree preferred.
- Customer service skills
- Knowledge of CPT and ICD-10 codes preferred.
- Knowledge of medical terminology preferred.
- 1-3 years of experience as an Intake Coordinator or comparable experience preferred.
Licenses, Registrations or Certifications:
- Certified Medical Assistant preferred.
Skills
- Organization skills
- Highly Professional
- Written & Verbal Communication
- Collaborative
