Texas Health Resources Call Center Intake Specialist SWHR CIN in Fort Worth, Texas
Southwestern Health Resources (SWHR CIN) seeks to hire a Healthcare Call Center Intake Specialist to work Full Time supporting the Utilization Management department.
Please note: Southwestern Health Resources Clinically Integrated Network (SWHR CIN) is an affiliated company of Texas Health and UT Southwestern. If hired for this position, you will become a SWHR CIN employee rather than a Texas Health or UT Southwestern employee.
The address is 900 Jerome Street, Fort Worth, Texas 76104 in the Midtown Medical Center.
Salary range is Min $14.85 - Max $20.40 – based on relevant experience
Handles high volume of inbound and outbound phone calls with excellent customer service
Consistently achieves first call resolution on every call
Responsible for meeting telephone system metrics set by the health plan to include length of call, length of answer time, and number of calls taken within a specific period
Performs high level of data entry
Follows standard operating procedures for updating authorizations, including precertification and IP notifications in Care Managements software
Updates Care Management appropriate wrap-up codes, break/lunch codes and any other codes for accurate and complete reporting
Meets any intake production or QA metrics
Responsible for processing, entering, triaging and routing all precertification and referral requests.
Ensures the overall data integrity of documents received and entered into computer system
Responsible for following non-clinical algorithms, network tier structure/exceptions, and precertification and referral requirements by health plan for initial organization determinations and referrals
Responsible for following all compliance and regulatory requirements for turn-around time, notification to provider/member, and accuracy/completeness
Supports UM/UE Clinical staff in obtaining clinical information and status of requests
Supports CM Clinical staff in processing referrals to the care management program
Responsible for supporting any assigned special projects pertaining to UM/UE functions, customer service, and care management
Responsible for outreach to providers to obtain necessary information to process precertification and referral requests
Consistently meets performance standards of production, accuracy, completeness and quality
Communicates actively and routinely with management team, and staff in handling client services, issues, escalated referral and preauthorization questions
Manages fax server, online requests and phone inquiries and processes requests from each
Secures patient demographics, verify benefits, and requests and enters clinical history as needed
Uses interpersonal/communication strategies with individuals to achieve: (a) desirable/acceptable outcomes/responses (b) perceptions of satisfaction or acceptance of those involved.
Perform procedures required by the assignment: (a) safely, without causing harm (b) effectively, achieving the intended outcome/result (c) efficiently, using the fewest possible resources (d) legally, within the scope of practice/policy
Establishes and/or revises priorities based on: (a) urgency of the patient or organization’s needs (b) resource availability (c) predetermined schedules (d) other departments/personnel expectations
Competes all compliance, regulatory and process training within the specified timeline
The ideal candidate will possess the following qualifications:
High School Diploma or Equivalent Required
Associate's Degree Preferred
2 years Full-time Medical Referrals and Preauthorization Experience in a Healthcare Setting Required
2 years Call Center Customer Service Experience Required
High level experience in data entry with accuracy
Excellent typing skills
Excellent phone etiquette
Ability to provide “customer service focus”
Work requires ability to communicate effectively with various levels of internal and external contacts
Work requires ability to work with confidential information on daily basis
Interpersonal and teamwork skills to contribute to objectives of organization
Adaptability/flexibility to react positively to changes in work environment
Initiative to improve productivity and quality of work
Knowledge of specific regulatory, Managed Care requirements
Must be proficient in various word processing, spreadsheet, graphics, and database programs including Microsoft Word, Excel, Access, PowerPoint, Outlook, etc.
Working knowledge and ability to apply professional standards of practice in work environment
Working Indoors 67% or more
Employment opportunities are only reflective of wholly owned Texas Health Resources entities.
We are an Equal Opportunity Employer and do not discriminate against any employees or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.