Intake Specialist

Responsibilities

• Collaborates with referral sources to determine which care coordination program best fits a referred member based on current clinical and health care needs and insurance eligibility.
• Marksets programs to external and internal parties to expand referrals as directed by supervisor.
• Checks referred members’ insurance eligibility status in EOHHS Virtual Gateway platform at time of intake and reauthorization or at times of loss to determine necessary action steps to retrieve insurance.
• Manages all incoming referrals for CSP including taking referrals via phone or CSP email and complete Referral Form.
• Completes Massachusetts Behavioral Health Partnership (MBHP) authorization process for qualifying CSP referrals via the Interactive Voice Registration system or with the Authorizing Representative and ensure authorization is recorded in the Provider Connect System.
• Completes Beacon authorization process via eService's system for qualifying CSP referrals.
• Completes authorizations for other funding sources as required, including Optum and Tufts.
• Conducts audits in eHana to identify expiring CSP Authorizations and complete all reauthorizations for an additional 90 days of service as assigned.
• Creates new CSP member records in eHana after referrals are approved by supervisor.
• Affords assistance in completing One Care referrals either directly with members via phone with Mass Health or with referral sources.
• Affords assistance in completing BHCP referrals with Mass Health or ACO/MCOs and troubleshoot referral problems.
• Affords assistance in regaining Mass Health when lost during service provision.
• Coordinates with internal programs to increase enrollment in Care Coordination entities (ACCS, Behavioral Health Clinics, clubhouses, other specialty programs).
• Completes enrollment documentation with CSP members when assigned by supervisor to include entering data in eHana for the MSDP Personal Information Form, providing orientation of services and after- hours information to the member and obtaining member signatures for Consent for Program Participation, Two-way Authorizations, Notice of Privacy Practices, and Grievance Procedures.
• Coordinates with Revenue Department and Director to fix identified problems with billing.
• Maintains updated roster of active CSP members and create Intake tracking reports.
• Manages process of obtaining and distributing acute care utilization information via daily review of Collective Medical Pre-Manage ED platform and coordination with involved acute care providers.
• Completes record reviews in eHana and other quality functions as needed for BHCP and One Care teams.
• Participates in regular team meetings.
• Seeks to maintain a constructive work environment and maintain effective communication with others.
• Maintains appropriate written and oral communication.
• Maintains confidentiality of member and employee information.
• Performs other related duties, as assigned.

Qualifications

• Minimum of two years of experience working in Human Services or healthcare industry and strong administrative and organizational skills are required.
• A high school diploma or equivalent is required. A Bachelor’s degree is preferred.
• In some cases, experience may be substituted for academic training.
• Ability to lift at least 25 pounds using proper lifting techniques.
• Ability to operate a computer and other office equipment such as a calculator, copier, and printer.
• Ability to remain in a stationary position 50% of the time as needed.
• Ability to bend, reach, file, sit, stand and move around the facility.
• Ability to speak, hear and communicate with clients, staff and external representatives.
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
• CPR required within two weeks of hire
• First Aid required within two weeks of hire