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Intake Specialist

2 months ago

Milwaukee, Wisconsin, United States Wellpoint Care Network Full time
Job Summary

We are seeking a highly organized and detail-oriented Intake Specialist - Billing to join our team at Wellpoint Care Network. The successful candidate will be responsible for managing the client registration and intake process, verifying insurance eligibility, and submitting prior authorizations.

Key Responsibilities
  • Client Registration and Intake
    • 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 electronic health records 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.
  • Billing and Payment
    • Utilizes payer eligibility websites to verify client insurance coverage and input changes and eligibility updates into electronic health records.
    • 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.
  • 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.
Requirements
  • 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 HIPAA 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 are required. Required reliable transportation to conduct on-site learning throughout the state.
  • Demonstrate an ability to effectively understand and practice cultural humility and ability to 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.