Health Services Coordinator

SUMMARY

The Intake HS Coordinator will support the Health Services Department in achieving clinical quality and service objectives by facilitating the referrals and authorizations process.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

• Stays logged into the phone and medical management queues on a daily basis.
• Monitors incoming requests for timely processing as per Leon Health’s policies and procedures and CMS requirements.
• Processes provider referrals and pre-authorization request per Leon Health’s policy and procedures.
• Contacts providers to verify or clarify requests.
• Contacts member/member’s representative for oral notification if applicable.
• Contacts provider for oral notification if applicable.
• Contacts Network Operations for Letter of Agreements, when necessary
• Contacts Courier service when needed.
• Updates members’ files in the system as appropriate.
• Forwards potential case management candidates to the Care Management Department.
• Communicates with the provider scheduling department when necessary.
• Serves as a resource for benefits and eligibility information to providers and other Leon Health personnel.
• Assists in peer training as needed.
• Participates in Quality Improvement and Risk Management activities as requested.
• Participates in training and in-service education as required.
• Participates in department and clinic meetings as requested.
• Complies with Leon Health’s policies and procedures and maintains confidentiality of patient’s medical records in accordance with state and federal laws.
• Maintains open channels of communication with other company departments.
• Answers all inquiries in a professional and courteous manner.
• Performs other duties as assigned.
• Rotating on call-weekends.

QUALIFICATIONS

• Strong organizational skills with the ability to function independently and as a team member.
• Excellent verbal, written, oral and listening skills.
• Excellent interpersonal skills.
• Minimum one-year managed care experience preferred in referral and/or preauthorization.
• Knowledge of personal computer and typing skills required.
• Knowledge of medical terminology required.
• Strongly self-motivated.
• Able to work effectively under a stressful environment.

LANGUAGE SKILLS

• Fluent in English and Spanish.

EDUCATION

• High School diploma