At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. This patient-first approach is what sets us apart as a leader in the healthcare industry. As an integral part of our team, you'll have the opportunity to join our quest for better healthcare, no matter where you work within the Northwestern Medicine system. At Northwestern Medicine, we pride ourselves on providing competitive benefits: from tuition reimbursement and loan forgiveness to 401(k) matching and lifecycle benefits, we take care of our employees. Ready to join our quest for better?

The Intake Specialist, Bariatric Surgery reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

The Intake Specialist serves as the point-of-entry, insurance expert, and appointment navigator for the Bariatric Surgery program. This position engages in front-end utilization management and per-protocol onboarding procedures to ensure a safe, efficient, and accurate patient care experience.

The Intake Specialist actively and effectively serves as a remotely functioning liaison for the bariatric surgery program to case managers, social workers, physicians, patients, and other referring partners. This role assists the patient and team through navigation efforts.

Responsibilities:

• Conduct eligibility verification, benefits investigation, test claims, pre-certifications, and prior authorizations for cases related to Bariatric Surgery. Assist in the coordination of appeals and/or peer-to-peer for prior authorization denials. Must have ability to navigate and execute functions within health insurance electronic portals and/or communicate with payer representatives via telephone.
• Actively communicate with members of the Bariatric Surgery team, patient, provider, and other stakeholders to provide updates on care progress. Communication mode (email, phone, progress note, warm hand-off, etc.) may vary depending on the audience and situation.
• Monitor and respond to requests for Bariatric Surgery services in an efficient, accurate, and professional manner via several platforms such as email, phone, and Epic.
• Exercise autonomy when reviewing prospective referrals. Leverage tools to make informed decisions about referral acceptance and denial. Maintain and update reference tools, as appropriate.
• Facilitate timeliness and access to care and coordinate complex care processes throughout Northwestern Medicine. Partner with the patient to provide direction as it pertains to pre-surgical / post-surgical requirements. Coordinate resources as needed.
• Work with Epic and other electronic portals to monitor and document key information as it pertains to the patient care journey. Keep the team abreast of new information.
• Provide accurate information and timely updates to patients and customers. Addresses questions and concerns promptly, or identifies appropriate person and resources to do so.
• Participates in efforts to reduce costs, streamline work processes, and improve services provided.
• Utilizes department and hospital policies and procedures to complete assigned tasks.
• Participate in team meetings, quality improvement initiatives, and other activities as requested.
• Assist with the onboarding and training of new members of the team.
• Other responsibilities as assigned and indicated.

Required:

• High School Diploma
• Three (3) years progressive work experience in any one of the following: hospital/physician utilization management, care coordination/navigation, medical billing, and/or pharmacy technician/certified medical assistant
• Demonstrates knowledge and compliance with insurance, local, state and federal regulations related to physician and hospital billing
• Knowledge of EPIC systems, Microsoft applications
• Ability to manage multiple priorities in a fast-paced environment.
• Exceptional organizational skills and detail orientation which includes ability to prioritize tasks and keep records so they remain readily retrievable.
• Excellent customer service and communication skills
• Experience that has contributed to the understanding of insurance rules and regulations, especially Medicare and Medicaid.

Preferred:

• Associate's degree or equivalent
• Five (5) years progressive work experience in any one of the following: hospital/physician utilization management, medical billing, utilization management, and/or pharmacy technician/medical assistant.
• Call center, telephone work experience
• High-level problem solving, analytical, and investigational skills
• Has a firm understanding of those Bariatric Surgery services covered by commercial, managed care, and federal payers.

Northwestern Medicine is an affirmative action/equal opportunity employer and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.