Intake Coordinator, Utilization Management
Evolent Health
Intake Coordinator: What You’ll Be Doing
This 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 from the 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 in 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.