UM Intake

Responsibilities:

• Professional interaction with Nurses, Insurance Adjusters and other medical professionals
• In-take / Data Entry of UM referrals and case assignment
• Loads cases for nurses daily, weekly, and monthly. Non-clinical staff manage large work queues across business lines (e.g., Medicare, maternity, pediatrics), assign tasks to nurses, verify case details, and prioritize urgent cases
• Evaluate faxes received by looking for identifying information and through thorough research in the Aerial system, file can be linked to opened requests by the clinicians that is instrumental in their completion of the review process.
• Scan, Upload and label case documents into appropriate case files
• Takes care of the administrative task for the clinicians through handling of Inbound faxes under the Managed Care Folder and ensures proper transmittal of documents to the appropriate queue.
• Collect medical files and documents to be scanned, indexed and uploaded to web base Utilization Review case management application
• Separate and sort EMR and documents
• Enable the clinician to plunge in to the review process of the document once queued by the Intake team
• Properly determine the correct path for the services requested from the received fax and move to the appropriate clinicians to review the case i.e. urgent care/non-urgent care that have different timetables/TAT that will impact NCQA
• Other tasks as assigned

Skills and Qualifications:

• Any college education (degree an advantage)
• At least 6 months of Healthcare BPO work experience
• Ability to multitask across multiple applications.
• Strong analytical skills with excellent attention to detail
• Excellent team player