Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow.

We’ve stayed true to our focus of finding qualified and experienced professionals in our specialty areas. Our partner-employers know that they can rely on us to find the right match between their needs and the abilities of our top-tier candidates. By continually exceeding their expectations, we have built successful ongoing partnerships that help us stay true to our commitments of performance and integrity.

Our team works hard to deliver a tailored approach for each and every client, critical in matching the right employers with the right candidates. We forge partnerships that are meant for the long term and align skills and cultures. At IRI, we know that our success is directly tied to our clients’ success.

Position Summary:

Under the direction of the Supervisor, Patient Care Management functions in the intake area. Responsible for intake specialist duties, Durable Medical Equipment responsibilities, as well as assisting with the orientation and training of intake specialists.

Principal Accountabilities:

1. Under the direction of the supervisor, assists in training, educating and guiding the development of new and existing intake specialists and Durable medical equipment specialists.

2. Adheres to Standard Operating Procedures, Process Standards and Policies and Procedures.

3. Utilizes and has knowledge of phone / service level requirements for compliance with governing bodies and standards.

4. Performs intake functions to meet real time, or as near to real time as possible, standards for departmental operations.

5. Responsible for pre-certification and recertification process for Durable Medical Equipment and selected outpatient therapies.

6. Interacts with internal and external customers in a real time manner to promote quality and excellent customer service.

7. Authorizes services based on Health Plan Guidelines. If unable to approve, submits the request to Health Plan Medical Director for medical necessity determination.

8. Receives information about care delivery service to members via facsimile, telephone, or letter. Create new member specific case in software program when indicated. Document information in software program.

9. Completes detail lines in MEDecision to reflect authorization or denial of services.

10. Verifies and documents member eligibility.

11. Routes case to appropriate Clinical Coordinators, Case Managers, DME specialists for continuation of medical necessity review process.

12. Communicates case specific information as indicated to Health Plan providers. Information includes, but is not limited to member identification number, provider identification number, Health Plan personnel/departmental telephone numbers, and case reference number.

13. Maintains professional, customer service focused demeanor in telephonic interactions with providers.

14. Meets individual required goals and contributes to the departmental service level standards for : Average speed of answer, Call abandon rate, Average hold time

15. Maintains a current knowledge base of computers and systems, and participates in learning and applying updates and changes.

16. Documents compliance with prior authorization process, Policy and Procedures.

17. Participates in Quality Reviews and Timeliness studies and achieves performance results at or above thresholds established by management.

18. Delivers customer service in a professional manner in all contacts.

19. Performs other related duties and projects as assigned.

20. Adheres to Health Plan s Policies and Procedures.

21. Supports and carries out the Mercy Mission and Values.

22. Complies with Health Plan, DPW and HIPAA confidentiality requirements protecting member personal identifiable health information.

Key Competencies/Success Factors:

Understanding of healthcare delivery system.

Demonstrated knowledge of medical terminology.

Problem solving skills.

Grammar/Proof reading skills.

Customer service and interpersonal skills.

Excellent telephone demeanor and skills.

Excellent oral and written communication skills.

Proficient PC skills in a Windows based environment.

Adheres to scheduled work hours.

Demonstrates knowledge of durable medical equipment.

Position Qualifications/Requirements:

1. Education and Training: High School Diploma and some college classes preferred.

2. Experience: Minimum one-year general office or customer service experience required. Work experience in healthcare setting utilizing medical terminology highly recommended.

3. Licenses, Registrations or Certifications: None Required.

With Regards

Kavita

(732) 549 5302