Intake Specialist - Milwaukee, United States - Wellpoint Care Network

Description

Job 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 will be responsible for the 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 required; Master's degree 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 benefits, 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.
• Proficient in the usage of computer software; demonstrate an understanding of computer file systems and computer software packages, e.g., Microsoft Office 365 suite of products, Excel, Word, Outlook, OneNote, Adobe Pro DC tools.
• 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.
• A valid Wisconsin Driver's License or occupational driver's license, and insurance is required. Or required reliable transportation to conduct on-site learning throughout the state.
• Ability to demonstrate critical thinking skills, detail oriented, highly effective verbal, and written communication skills.
• Demonstrate an ability to effective understanding and practice of cultural humility and ability work and communicate respectfully with individuals from diverse backgrounds.
• Keeps Supervisor and appropriate staff advised of pertinent situations/problems, ideas, etc. and makes recommendations for improvement.
• 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.

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

•Completes the writing, submission and follow up on Prior Authorizations for psychotherapy and occupational therapy services.

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

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

•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 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.

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

•Maintains knowledge of Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans and procedures requiring prior authorization and current accepted insurance plans.

Prior Authorizations

•Creates and submits Prior Authorizations for psychotherapy and occupational therapy 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.

•Provides the highest level of client customer service by problem solving, documenting patient concerns and contact, and identifying appropriate follow-up.

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

Position Details & Extras:

• Full time.
• Onsite / Hybrid 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.
• May require travel to attend meetings and events.

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

*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