Position Summary:

Is responsible for distributing admission information according to company policy; prioritizing phone calls; ensuring admission packets are available and appropriate; and interpreting insurance policy benefits to accurately reflect coverage amounts and Client co-pay (prior approval of insurance authorization). The Intake Specialist must be able to discuss and relay appropriate clinical information to obtain authorization for Home Care Services. They are also responsible for accurate data entry of referral data into HCMS. Abide by and demonstrates the company Mission, Vision, and Guiding Principles through both behavior and job performance on a day-to-day basis.

Essential Duties & Responsibilities:

• Accurately enters all demographic, financial and referral data in to the computer systems to facilitate billing and scheduling in a timely manner.
• Answer phones and appropriately routes referral calls. Routes calls based on clinical needs.
• Prioritizes phone call for follow up (i.e., doctors, insurance company)
• Back up to Intake Supervisor by preparing the client referral for clinical services, and loading new referral sources, in accordance with company policy, state and federal guidelines and private insurance contracts.
• Monitors the web-based program, “Allscripts”, for open referrals and respond as needed.
• Assist with accepting physician orders, as needed.
• Appropriately prioritizes referrals so that the most urgent needs are met first. This includes consulting with CTM’s, schedulers, and referral sources for coordination of admission dates ad times.
• Calculates co-pays and deductible amounts as per insurance reimbursement rates.
• Completes all necessary documentation for initial authorization in accordance with the insurance company contracts.
• Completes all request for all follow up authorization as needed, notifies staff of all authorizations received and visit limits as well as need to discharge client due to denial for further authorization.
• Participates in communications and resolution of problems with insurance interpretation. Identifies insurance carriers and verifies benefits and eligibility.
• Collaborates with CTM/Case Manager on authorized visit to assure accurate utilization for patient needs.
• Follow up with AE/Liaisons via text or email to assure notification of referrals received and documentation needed.
• Answer text or calls on weekends and after hours for insurance questions of new referrals.
• Acts as backup to clinical staff and assist as necessary with copying, faxing, etc.
• Demonstrates the ability to make customers feel satisfied and appreciated.
• Maintains an understanding of the company’s scope of services.
• Understands the infrastructure and how and where to transfer calls in the company.
• Maintains a professional image.
• Uses appropriate phone etiquette.
• Promotes a customer friendly atmosphere for all visitors and ensures patient confidentiality at all times.
• Participates in accreditation program.
• Assist referral sources with finding placement for patient that company cannot accept due to insurance reasons.
• Passes on all outstanding referrals and details to the night time/ weekend intake supervisor, via phone/ email.
• Maintains daily referral report and sends out to assigned staff.
• Performs other duties as assigned.

Licenses, Certifications and/or Registrations:

• Current Florida LPN license required.
• Dependable transportation with valid driver’s license and auto insurance

Education/Experience:

• Graduate of an accredited LPN program.
• Minimum three (3) years of prior experience in a medical field or medical office setting is preferred.
• Knowledge of billing, insurance reimbursement, medical terminology, diagnosis coding preferred.
• Experience with trouble shooting computer errors, maintaining records, and organizing is preferred.
• Proficiency using Microsoft Word, and Excel is required.
• Able to prioritize and manage time effectively and make independent decisions when necessary.

Working Conditions:

Office Environment. May be exposed to biological hazards.