Intake Specialist

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 escalate 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