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.