Intake Coordinator/ Precertification Specialist

About the Role

Brighton Health Plans Solution is looking for an Intake Coordinator with prior experience in a similar role with good multitasking and communication skills. You will be utilizing your knowledge of medical terminology, medical specialties and HIPAA Confidentiality laws.

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities and activities may change, or new ones may be assigned at any time with or without notice.

Primary Responsibilities

• Answer and handle call center calls within required time frames.

• Collect data upon notification from patient/patient representative, physician, or hospital; verify member eligibility, plan participation and provider participation status.

• Create cases within Medical Management system in accordance with departmental workflows, policies, and procedures.

• Data entry of required case information including transcription of clinical information

• Interact telephonically with employers, employees, physicians, and insurance adjusters to determine medical status, type of care needed (surgery, hospitalization and/or physical therapy) and future needs of care as needed.

• Maintain accurate records of individual cases; create, scan, fax and upload correspondence and documentation as required.

• Inform callers that the Nurse Case Reviewer may obtain additional medical information for review and certification.

• (In regard to discharge planning for workers’ compensation patients) direct participants to facilities and providers as close to their desired location as possible. Reductions, restrictions, and coordination of special situations are also communicated.

• Adhere to established quality assurance standards and all MagnaCare policies and procedures.

• Mail correspondence to member/provider/facility.

• Discuss and document any concerns, complaints and/or issues with direct supervisor.

• Is kind, caring, sympathetic and positive with all customers and fellow employees.

Essential Qualifications

• HS diploma or GED is required.

• Strong skills in medical record review.

• Excellent customer service and communication skills.

• Ability to define problems, obtain data, and establish facts.

• Ability to work proficiently on a computer (PC) with working knowledge of Microsoft Word and Excel.

• Excellent data entry skills.

• Familiarity with medical terminology (ICD10 codes, CPT/Diagnostic codes)

• Bachelor’s degree preferred, but not required.

• Current knowledge of workers compensation and legislative issues a plus.

• Previous experience in case management handling insurance claims a plus.

• Ability to work in a database environment a plus.

About

At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all of your unique abilities.

Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions.

Come be a part of the Brightest Ideas in Healthcare™.

Company Mission

Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners.

Company Vision

Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.

DEI Purpose Statement

At BHPS, we encourage all team members to bring your authentic selves to work with all of your unique abilities. We respect how you experience the world and welcome you to bring the fullness of your lived experience into the workplace. We are building, nurturing and embracing a culture focused on increasing diversity, inclusion and a sense of belonging at every level.

*We are an Equal Opportunity Employer

Annual Salary Range: $39,520 - $46,800

The salary range and/or hourly rate listed is a good faith determination that may be offered to a successful applicant for this position at the time of the posting of an advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable by law including but not limited to location, years of relevant experience, education, credentials, skills, budget and internal equity.