Community Health Network of Connecticut, Inc. (CHNCT) is currently seeking a Non-Clinical Intake Representative.

Primary Responsibilities:

• Responsible for triaging all incoming calls into the Utilization Management Unit, entering referrals into system, requesting all clinical information and forwarding any referral requiring medical necessity determination to clinical staff.
• Provides support for claim related provider appeals.

Tasks Performed:

• Reviews all referrals for completeness, verifies eligibility and verifies that provider is in network. Assists with entry of new hospital admissions.
• Maintains knowledge of covered benefits of Medicaid programs.
• Identifies and refers for coordination of benefits (COB) and third-party liability (TPL) as appropriate.
• Maintains confidentiality of member specific records.
• Acts as preceptor to new staff.
• Performs other duties as assigned.

Essential Functions:

• Responds to telephonic requests by providers for authorization and benefit coverage for CHNCT members for all lines of business.
• Approves services based on benefit package.
• Performs data entry for specialty visits, rehabilitation, DME, etc. Interacts with providers and vendors to collect necessary medical information and office notes needed to support clinical staff in decision making.
• Identifies service requests for non-par providers and services outside of member benefit packages and refers to clinical staff.

Desired Education: Secondary schooling

Desired Degree: High school diploma or GED

Other Qualifications: Claims processing background preferred. Excellent interpersonal/telephone communication skills. Knowledge of medical terminology, ICD9 and CPT 4 coding. Strong word processing and data entry skills. Ability to handle several tasks concurrently.

CHNCT Offers Great Benefits:

• Medical, dental and vision coverage options
• Flexible spending and health savings accounts
• Group term life insurance
• A 401(k) plan with company-match and immediate vesting
• Voluntary accidental injury coverage
• Tuition reimbursement and continuing education opportunities
• A generous paid-leave bank and company holidays
• Wellness program

CHNCT is an equal opportunity, affirmative action employer m/f/d/v and proud of the diversity of our workforce.

Important Note to Applicants: CHNCT as a company feels very strongly that we need to do what we can to help control the spread of COVID-19 infections. Therefore, all employees, contractors, consultants and agency temporary staff are required to be fully vaccinated to work at CHNCT. Reasonable accommodations for medical or religious exemptions will be provided with appropriate documentation for positions that do not have in-person/member visitation requirements.