EMERGENCY ROOM INTAKE COORDINATOR

Job Summary:

The Emergency Room (ER) Intake Coordinator coordinates and supports activities related to case management and ED utilization. Performs research to include member demographics, health and history, ECM/CCM enrollment, approved authorizations, and creates cases for outreach. Provides clerical assistance and prepares reports for the Manager of Case Management.

Responsibilities:

• Answers telephone in a prompt, professional, courteous and helpful manner; screens and directs calls to appropriate staff members or departments.
• Effectively work with providers, nurses, case managers, UM/QM Manager(s), and Medical Directors and/or any other colleague/customer/patient.
• Receives and enters appropriate information from referrals.
• Assists with examination of records, related documents, corresponds with providers and health plan personnel to obtain facts regarding members.
• Verifies member eligibility by systems inquiry or health plan contact.
• Requests clinical records per procedure.
• Accurately applies appropriate policies, procedures, and eligibility and benefit policies.
• Maintains current knowledge of provider network as it continues to develop and change.
• Prepares, communicates and monitors effective follow up plans for patients which may include coordination/input from multiple departments and utilizing information gathered during research.
• Effectively manages projects and objectives in a timely manner.
• Develops positive and professional working relationships with providers, nurses, case managers, and Medical Directors to ensure system inputs of electronic and manual referrals are processed, timely, accurately and within production standards.
• Adheres to company policies, procedures, guidelines and directives. Recognizes and enforces company security measures, maintains strict confidentiality and complies with HIPPA standards.
• Enhances professional growth and development through in-service meetings and educational programs.
• Assist department in identifying opportunities for workflow improvements.
• Contributes to a healthy, positive and safe environment while promoting self as a team member.
• Maintains strict confidentiality.
• Performs related duties consistent with the scope and intent of the position.
• Regular attendance.
• Travel as required.

Other Functions

• Enforces Company policies and safety procedures.
• Regularly updates job knowledge by participating in educational opportunities, reading professional publications, maintaining professional networks, and participating in professional organizations.
• Maintain IPA, Health Plan compliance standards.

Competencies

• Two (2) + years of utilization management coordination experience is required.
• Three (3) + years’ experience in the medical field is required.
• Ability to type a minimum of 45 WPM.
• Ability to professionally and efficiently manage intake activities.
• Ability to multi-task, solve problems and analyze data in a fast-paced environment.
• Ability to intervene and diffuse difficult calls.
• Demonstrates a comprehensive knowledge of Health Plan Benefits, DOFR, EMR, and the various departmental functions.
• Demonstrated ability to assess, evaluate and interpret medical information.
• Proficiency with computer and standard business software (MS Office applications) and ability to learn in-house and other systems quickly with minimal training.
• Strong oral and written communication skills, with the ability to communicate professionally with diverse individuals and groups internal and external to Vivant.
• Ability to consistently deliver excellent customer service.
• Ability to solve mid-level problems with minimal supervision.
• Excellent active listening and critical thinking skills.
• Ability to multi-task, exercise excellent time management, and meet multiple deadlines.
• Ability to provide and receive constructive job and/or industry related feedback.
• Ability to maintain confidentiality and appropriately share information on a need-to-know basis.
• Ability to exercise sound discretion and strict maintenance of confidentiality of all confidential and sensitive communications and information.
• Excellent attention to detail and ability to document information accurately.
• Ability to effectively and positively work in a dynamic, fast-paced team environment and achieve objectives.
• Must have high-level skills in Microsoft software (Word, Excel, Outlook).
• Must have the ability to quickly learn and use new software tools.
• Must have mid-level skills using e-mail applications.
• Self-motivated with strong organizational, multi-tasking, planning, and follow up skills.
• Ability to work independently as well as in a team environment.
• Demonstrate commitment to the organization’s mission.
• Ability to present self in a professional manner and represent the Company image.

Education and Licensure

• High School Diploma or GED minimum.
• Minimum of two years advanced education from an accredited educational institution preferred.
• Medical Assistant Certification preferred.

Travel

• The incumbent may travel up to 5% of the time.

Supervisor Responsibility

• This position does not have any supervisor responsibilities.

Work Environment

This job operates in a professional office environment. This role routinely uses office equipment such as computers, phones, photocopiers, scanners and filing cabinets.