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Intake Specialist

3 months ago

Milwaukee, United States Wellpoint Care Network Full time
Job DescriptionJob Description

At Wellpoint Care Network, our mission is to facilitate equity, learning, healing, and wellness by restoring the connections that help children and families thrive.

Every person deserves the opportunity to reach their fullest potential. It’s part of human nature, and the promise of our country, that everyone be given a fair chance to be and do their best. Yet, many in our community live with unresolved childhood and generational trauma.

That’s where we come in. We believe we can create a world where children and families have a clearer path to their fullest potential. Wellpoint Care Network has championed the restoration of families for nearly 175 years.

Job Purpose:

Our next Intake Specialist – Billing will be responsible for client registration and intake process, which includes obtaining and entering demographic information, sending requests for client information and consents via EHR and/or Adobe Pro DC, and verifying insurance eligibility, benefits, and network status for clients served in an outpatient clinic setting. This position will also be responsible for prior authorization submission and follow-up on eligibility or billing issues for current clients.

Qualifications:

  • Bachelor’s degree in healthcare, business or other related field required.
  • Master’s degree in healthcare, business, or other related field preferred.
  • A minimum of 3 years’ experience working with an electronic health record (EHR) system with data entry experience required.
  • A minimum of 3 years’ experience required of medical/mental health office experience with working knowledge of Medicaid, Medicare and Commercial health plans and must understand, be able to convey to clients, and call insurance plans about insurance eligibility, benefits and network status to include but not limited to copay, coinsurance, deductible, out-of-pocket maximum, in-network, out-of-network, EAP, Prior Authorizations, Single Case Agreements, etc.
  • Must have a working knowledge of the International Classification of Diseases (ICD-9-CM, ICD-10-CM), current Procedural Terminology (CPT-4) coding.
  • High level customer service experience and client satisfaction.
  • Excellent communication skills both verbal and written. Business writing skills, including good spelling, punctuation, and sentence structure.
  • Ability to organize and complete projects in a timely manner.
  • Excellent problem-solving, decision making, and communication skills.
  • Maintains confidentiality and adheres to all HIPPA requirements.
  • Must be able to create, convert, combine, organize, and modify files. Must be able to create fillable forms and form templates, request signatures, etc.
  • Ability to use and maintain various types of office equipment including phones, computer software/hardware, fax and eFax, scanner and copying machines.
  • Must be honest, dependable, and able to meet deadlines; Self-motivated and able to work independently.
  • A valid Wisconsin Driver’s License or occupational driver’s license, reliable transportation and insurance is required. Required reliable transportation to conduct on-site learning throughout the state.
  • Demonstrate an ability to effective understanding and practice of cultural humility and ability work and communicate respectfully with individuals from diverse backgrounds.
  • Proficient in the usage of computer software; demonstrate an understanding of computer file systems and databases, e.g., Microsoft Office, Excel, Outlook, Teams, ADP, etc.
  • Physical exam, drug screen, motor vehicle report, and background checks are required for this position.

Duties:

Intake and Insurance

•Tracks, maintains, confirms, and secures referrals and contributes to obtaining information needed to accept referral.

•Schedules new client appointments and transportation, as necessary.

•Performs registration responsibilities; obtain, enter, and update demographic information; send requests for client information and consents via EHR and/or Adobe Pro DC; and verifies insurance eligibility, benefits, and network status.

•Ensures accurate client information is entered, and necessary insurance and referral documents are uploaded into electronic health records.

•Monitors Medication Management intakes, insurance coverage, appointments, orders, and requests from psychiatrist.

•Completes client risk assessment and crisis triage for all new referrals, provides resources for immediate support and connects to clinical team if identified high risk.

•Manages client information tracking on Clinic Caseload Excel spreadsheet with a working knowledge of provider licensing types to include maintaining and modifying data, rows/columns, worksheets, and workbook.

Billing and Payment

• Utilizes payer eligibility websites to verify client insurance coverage and input changes and eligibility updates into EHR.

•Communicates with clients via phone or mail to obtain additional insurance information and interacts with departments/clinics to resolve charging issues affecting the claims.

•Updates insurance, financial responsibility and other data when changes or additions occur and communicates to client as appropriate.

•Utilizes knowledge of CPT and ICD-10 codes, billing modifiers, and billing rules in accounts receivables processing.

•Investigates and resolves EHR billing task issues; review codes, modifiers, eligibility and utilize high level problem-solving skills to resolve.

•Educates clients regarding referral and authorization requirements, payer coverage, eligibility guidelines, and insurance related changes and clinic financial options.

•Maintains knowledge of Medicare, Medicaid and third-party payer requirements, accepted insurance plans along with requirements for reviewing network status, benefits, and eligibility.

Prior Authorizations

• Maintains knowledge of prior authorization requirements, and submission.

•Creates and submits Prior Authorizations for psychotherapy, occupational therapy, and medication services as required by insurance type.

•Maintains database and routinely follows up on prior authorizations, EAP authorizations, single case agreements, sliding scale approvals, Self-pay, and out of network cases.

•Notifies therapists in advance of due dates and serves as a resource to staff to facilitate timely completion.

•Processes Records Requests with assistance of Clinic Manager.

Agency Engagement

•All employees will be evaluated on their demonstration of a consistent commitment to the Agency’s Seven Essential Ingredients, Diversity, Equity and Inclusion, and engagement in the strategic initiatives of the organization. This will be measured by their active participation in committees, workgroups, and by their communication and practice within their daily work and in the community.

•Participates in assigned meetings, events and learning as required.

•Other duties as assigned, including serving in a coverage role for other department members.

Position Details & Extras:

  • Full time.
  • Quantitative/mathematical ability (addition, subtraction, multiplication, division, standard measurements).
  • Hybrid on-site/remote work is available with reliable broadband connection.
  • Fast paced, flexible work schedule includes evenings and some weekends to accommodate program needs.
  • Moderate exposure to noise.
  • Subject to frequent interruptions with ability to manage multiple tasks simultaneously.
  • Demonstrates an understanding of the cultural differences among diverse groups and the need to adapt service provision to match these differences in respectful ways.
  • Public Service Loan Forgiveness (PSLF) - Wellpoint employees may be eligible for loan forgiveness under the Public Service Loan Forgiveness program.
  • Exhibits professionalism in all aspects of practice; adheres to agency’s code of conduct and expectations, policies, and safety standards. Demonstrates a desire to develop professional skills.
  • Works well with other team members. Prior to approved time off, coordinates and verifies that all reception responsibilities needing to be conducted during absence are covered by appropriate colleagues.
  • Keeps Supervisor and appropriate staff advised of pertinent situations/problems, ideas, etc. and makes recommendations for improvement.

Organizational Information:

At Wellpoint Care Network, we have seen exactly how trauma, poverty, systemic racism, social injustices, and other barriers create instability in all areas of life. The people in our care face education and health disparities, high unemployment rates and unaffordable housing. What’s worse, many have lost connections to resources, family, friends, and other support systems. We have seen the toll it has on a person’s physical, emotional, and financial well-being to try and successfully navigate complex systems that may have failed them in the past.

We believe there is a better way. So, we have anchored ourselves in our 170 years of caring for our neighbors through modernized human services.

Wellpoint Care Network provides a rich continuum of services, including:

• Child Welfare and Foster Care

• Support for youth who have aged out of care

• Care Coordination and Wraparound services

• Mental health therapy and supports such as our Clinic, Family Preservation, Caregiver Support, and Integrated Community Treatment

• Professional education and clinical consultation (for organizations, schools, and individual/family)

Wellpoint Care also works to promote a diverse and caregiving environment to ensure that those we serve, and employ are valued, accepted, respected, and treated equitably.

• Equity means we work tirelessly toward fair and just treatment, systems, and policies. At Wellpoint Care Network, we believe that we are accountable – individually and collectively – when inequity or injustice replaces equity and inclusion.

• Inclusivity means that we consciously build groups that welcome and celebrate differences in age, race, ethnicity, class, gender, sexual orientation, religion, gender expression, education, socio-economic background, personal history, geographical location, marital status, parental status, and work experiences.

Interested parties please apply online. We are committed to enhancing diversity, equity and inclusion and strongly encourage minority candidates to apply. For more information, visit our website www.wellpointcare.org.

*To protect the health and well-being of our employees, clients, and community members we come in contact with on a daily basis, Wellpoint has decided to mandate the COVID vaccine for all employees or be approved with a qualified exemption. Please note that job candidates must be partially vaccinated within thirty (30) days of hire, and fully vaccinated within sixty (60) days of hire or approved for an exemption. *

Equal Opportunity Employer