We are seeking a highly motivated and detail-oriented
Intake Specialist
to join our team. This position is open due to increased workload demands, and we are looking for someone who can effectively manage a fast-paced environment while maintaining accuracy and professionalism. The ideal candidate will possess strong customer service skills, the ability to quickly learn new tasks, and the confidence to proactively communicate with team members when assistance is needed.
Must be a DC resident.
Responsibilities
Receive and process incoming information accurately and efficiently
Manage a high-volume workload while maintaining attention to detail
Provide excellent customer service when interacting with clients and stakeholders
Quickly learn and adapt to new processes and responsibilities
Communicate effectively with supervisors and team members
Work independently while remaining collaborative
Process requests following physician review; evaluate language and collaborate with reviewers or managers to ensure determinations are complete before issuing provider communications
Obtain clinical information from client systems or contact providers to secure required documentation for review
Determine, based on training and contract requirements, when a scripted review is appropriate
Provide notification of completed reviews and request additional information when necessary
Communicate case details and notifications through inbound and outbound calls
Enter case information from source documentation or validate information submitted through the provider portal
Perform Medicaid verification for providers and beneficiaries/members; validate submitted requests for accuracy and completeness
Assist providers with submitting documentation for utilization review and other medical management services
Enter non-clinical or structured clinical data into the system
Screen cases to confirm required medical information is sufficient for clinical review
Respond to inbound calls and document interactions clearly in the care management system
Scan, upload, and label case files and related documentation
Address routine and time‑sensitive inquiries and escalat[e] complex issues as appropriate
Report HIPAA or PHI violations through appropriate channels
Report Quality‑of‑Care concerns to appropriate leadership
Enter case information into organizational and/or state Medicaid electronic medical record (EMR) systems
Conduct courtesy calls referencing case numbers
Prepare and build cases within the care management system
Document and upload correspondence into the state Medicaid system
Support orientation and training of non‑clinical staff
Develop templates for complex reviews, conduct internal quality reviews, and participate in provider outreach as requested
Perform scripted reviews when applicable and refer cases requiring additional action to clinical review staff
Coordinate non‑clinical functions and interventions as directed
Close cases under supervision upon completion of review
Shift Monday - Friday 8:30a-5p
#J-18808-Ljbffr
Intake Specialist
to join our team. This position is open due to increased workload demands, and we are looking for someone who can effectively manage a fast-paced environment while maintaining accuracy and professionalism. The ideal candidate will possess strong customer service skills, the ability to quickly learn new tasks, and the confidence to proactively communicate with team members when assistance is needed.
Must be a DC resident.
Responsibilities
Receive and process incoming information accurately and efficiently
Manage a high-volume workload while maintaining attention to detail
Provide excellent customer service when interacting with clients and stakeholders
Quickly learn and adapt to new processes and responsibilities
Communicate effectively with supervisors and team members
Work independently while remaining collaborative
Process requests following physician review; evaluate language and collaborate with reviewers or managers to ensure determinations are complete before issuing provider communications
Obtain clinical information from client systems or contact providers to secure required documentation for review
Determine, based on training and contract requirements, when a scripted review is appropriate
Provide notification of completed reviews and request additional information when necessary
Communicate case details and notifications through inbound and outbound calls
Enter case information from source documentation or validate information submitted through the provider portal
Perform Medicaid verification for providers and beneficiaries/members; validate submitted requests for accuracy and completeness
Assist providers with submitting documentation for utilization review and other medical management services
Enter non-clinical or structured clinical data into the system
Screen cases to confirm required medical information is sufficient for clinical review
Respond to inbound calls and document interactions clearly in the care management system
Scan, upload, and label case files and related documentation
Address routine and time‑sensitive inquiries and escalat[e] complex issues as appropriate
Report HIPAA or PHI violations through appropriate channels
Report Quality‑of‑Care concerns to appropriate leadership
Enter case information into organizational and/or state Medicaid electronic medical record (EMR) systems
Conduct courtesy calls referencing case numbers
Prepare and build cases within the care management system
Document and upload correspondence into the state Medicaid system
Support orientation and training of non‑clinical staff
Develop templates for complex reviews, conduct internal quality reviews, and participate in provider outreach as requested
Perform scripted reviews when applicable and refer cases requiring additional action to clinical review staff
Coordinate non‑clinical functions and interventions as directed
Close cases under supervision upon completion of review
Shift Monday - Friday 8:30a-5p
#J-18808-Ljbffr