Intake Coordinator
Job ID: J171995
Company: Gateway Health
Location: Pittsburgh,PA,US
Full/Part Time: Full time
Job Type: Day (United States of America)
AHN Facility:
Posted Date: January 9, 2021
JOB DESCRIPTION
Company :
Gateway Health Llc
Job Description :
JOB SUMMARY
This job captures all inbound appeals and grievance requests from providers and/or subscribers. The incumbent assesses the request, conducts all necessary research such as verifying benefit coverage for the patient, denial codes, par or non-par provider status and then creates the case (data entry) in the online processing system. Ensures all accurate information is entered at the onset of the process to ensure adherence to all regulatory compliance requirements and service level agreements. The requests may come via fax or mail and may require checking multiple systems. The incumbent is expected to meet established quality and production standards.
ESSENTIAL RESPONSIBILITIES
- Obtain requests from provider, member or pharmacy via fax or mail.
- Use multiple software systems and various resource sites to determine the type of request (member or provider appeal).
- Build cases in the online processing system.
- Identify if the submission is additional information received for a current case. When necessary, forward to the responsible analyst.
- Ensure accuracy of data entry to prevent compliance and/or downstream process issues.
- Sort and scan incoming mail, and mail correspondence to members and/or providers.
- Complete outbound calls when additional information is required.
- Identify expedited appeals based on key terms/phrases.
- Save medical information to disk.
- Other duties as assigned.
EDUCATION
Required
- High School Diploma/GED
Substitutions
- None
Preferred
- None
EXPERIENCE
Required
- 1 year of experience working in the Healthcare Industry
Preferred
- None
LICENSES AND CERTIFICATIONS
Required
- None
Preferred
- None
SKILLS
- Oral & Written Communication Skills
- Telephone Skills
- Data Entry
- Microsoft Office Suite (Word, Excel and Outlook)
- Attention to Detail
- Problem Solving & Decision Making
- Compliance
- Healthcare Industry
- Health Insurance
Language (Other than English)
None
Travel Required
0% – 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-Based
Teaches / trains others regularly
Rarely
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Occasionally
Lifting: 10 to 25 pounds
Rarely
Lifting: 25 to 50 pounds
Rarely
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
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Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
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BENEFITS
Total Rewards Program
In addition to competitive pay rates and flexible career growth, we show our employee appreciation through a comprehensive Total Rewards package, including:
- Medical and prescription drug, dental and vision coverages for your and your eligible dependents
- Health Saving and Flexible Spending Accounts
- Life, AD&D and disability insurance
- Employer-sponsored 401(k) plan
- Paid time off, including paid holidays
- Tuition reimbursement
- Volunteer opportunities
- Voluntary benefits
- Employee discounts
Wellness Resources and Programs
Employees have access to the following wellness programs and resources:
Employees have access to the following wellness programs and resources:
- Work-life resources, such as employee assistance programs and financial counseling services
- 24/7 telephone access to health and wellness coaching to achieve personal goals
- Onsite pharmacy services at major campuses
- Fitness center access for all employees inclusive of showers, lockers, and group exercise classes at major Highmark campuses, Allegheny General Hospital & West Penn Hospital
- Access to chronic condition management programs when enrolled in the employer-sponsored medical plan
- 100% coverage for preventive exams, including flu shots
- Incentive program that rewards employees
- Secure bicycle parking at major campuses
- Healthy food options at onsite cafeterias
- Employee networks to gather in the name of health
- Onsite seated massage and stress management classes including yoga, mindfulness and meditation
LIVING IN PITTSBURGH
Pittsburgh, PA is home to Highmark Health’s corporate headquarters, as well as the headquarters of many of our businesses and a majority of our career opportunities. When you live and work in Pittsburgh, you’ll experience a wide variety of lifestyle advantages. Take a look around and you’ll quickly see why Pittsburgh is one of America’s most liveable, most affordable, safest and happiest cities. Learn more about this exciting and inviting location:
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