INTAKE SPECIALIST in Morrisville, NC at Beacon Health Options

Date Posted: 7/18/2018

Job Snapshot

Job Description

General Summary     The Clinical Intake Specialist follows a script to perform intake functions, supported by explicit instructions and scripts, monitored by a licensed health professional, and promptly transfer a telephone call or case to a clinical reviewer if the review cannot be completed based on a formal script for MHSA. The Clinical Intake Specialist will enter authorizations to facilitate claims payment when a medical necessity determination is not necessary.   Screens incoming calls and provides appropriate information and referrals in accordance with policies and procedures. Completes CareConnect registration screens and inquiry tracking screens for routine requests.  For EAP services the Intake Specialist may complete telephonic assessments and referrals for routine EAP referrals.

Duties and Responsibilities

  1. Collects structured clinical data.

  1. Accepts responses to structured clinical data.

  1. Performs review of service requests, scripted clinical screening or acquires structured clinical data with monitoring by a licensed health professional, and completes documentation in accordance with policy standards.

  1. Promptly transfers a MHSA telephone call/case for review by a licensed professional if the review cannot be completed based on a formal script. 

  1. Transfers calls to a CCM or Clinical Supervisor when necessary for further assessment.

  1. Researches and responds promptly to member and provider inquiries regarding eligibility, benefits, and claims.

  1. Follows all internal Policies and Procedures, and related Work Flows to maintain adherence to regulatory and accreditation standards.

  1. Maintains confidentiality, adhering to Beacon Health Options Policy and Procedures and Benefit Plan requirements.

  1. Responsible for data entry of clinical information into review forms in CareConnect.

  1. Makes “courtesy calls” to facilities/providers on service requests.

  1. Makes phone calls to providers to request additional information, per scripted protocols, as requested by care managers; documents information in inquiry per protocol.

  1. Maintains departmental productivity and performance standards.

  1. Participates in QM process with regular audits of work completed.

  1. Other duties as assigned to allow care managers to work on clinical assessments and review.

  1. Other duties may include:
    1. Non scripted telephonic assessments for routine EAP services.
    2. Outreach and follow up on routine EAP cases.

Minimum Entry Level Qualifications

  • Education:  Masters Degree in a health related field required plus three years of experience working in a healthcare environment with a high level of customer service. 
  • Years and Type of Relevant Work Experience: At least three years of progressive experience in customer service or healthcare required.  

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