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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

Work Schedule

Monday-Friday 8am-5pm

Job Description

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

Qualifications

The ideal candidate will possess the following qualifications:

Education

High School Diploma or Equivalent Required

Associate's Degree Preferred

Experience

2 years Full-time Medical Referrals and Preauthorization Experience in a Healthcare Setting Required

2 years Call Center Customer Service Experience Required

Skills

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

Supervision

Individual Contributor

ADA Requirements

Working Indoors 67% or more

Physical Demands

Sedentary

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.

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