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Kern Family Health Care · 13 hours ago

Non Clinical Intake Coordinator III Certified

KHS Buck Owens Office, 2900 Buck Owens Blvd., Bakersfield, California, United States of America

Full-time

Hybrid

Entry, Mid Level

$28.62/hr - $36.49/hr

2+ years exp

Kern Health Systems is dedicated to improving the health status of its members through an integrated managed health care delivery system. The Non-Clinical Intake Coordinator III will support the Clinical Intake staff in processing health plan referrals and provide administrative support to the Utilization Management Department, ensuring accuracy and timeliness in the authorization process.

Health CareHospitalNon Profit

Growth Opportunities

Responsibilities

Screen calls from KHS providers and KHS members regarding the KHS UM process

Obtain referral information from providers and members to implement and facilitate the authorization process

Act as liaison to KHS members, community providers, and employees to the UM clinical staff

Assigns diagnostic and procedural codes using ICD10, and CPT coding classification system for service requests. Requests input from the Clinical Intake Staff when needing direction or clinical expertise

Reviews specified referral types using established criteria for purposes of pre-authorization of payment, when indicated routes requests to Clinical Intake Coordinators for approval or auto-authorizations

Benefits interpretation to include coordination of care for medically necessary services that are not covered under the KHS Plan (e.g. CCS, and State Waiver Programs.)

Obtains additional medical information for clinical staff for preparation of authorizations for Clinical Intake Coordinator review

Coordination of Health Plan services between KHS UM Department and KHS Member Services and Provider Relations

Reviews member history and eligibility and previous referral authorizations

Monitors, tracks, and processes provider service appeals

Ensures accurate data entry of authorizations in the QNXT system

Acts as a resource to Non-Clinical Intake Coordinator Level I and Non-Clinical Intake Coordinator Level II staff

Adheres to KHS’s Code of Ethics and Business Conduct and all company policies, e.g., confidentiality, attendance, safety/security, use of equipment and technology, appearance and demeanor

Performs other job-related duties as assigned

Adheres to all company policies and procedures relative to employment and job responsibilities

Qualification

ICD-10 codingCPT codingManaged care experienceData entryMedical terminologyTyping certificateHigh School DiplomaCommunication skills

Required

High School Diploma from an accredited school or equivalent

Medical Assistant associate's degree/diploma or Medical Assistant Certificate or Certified Nurse Assistant (CNA) required

Minimum of two (2) years of experience in a managed care setting

Data entry and computer experience of at least two years

Proficient in ICD-9, ICD-10, and CPT coding procedures

Experience with medical terminology

Typing certificate for 30 wpm

Company

Kern Family Health Care

Kern Health Systems, known as Kern Family Health Care, was established in 1993 as a managed care health plan, and is the largest health plan in Kern County.

Founded in 1993

Bakersfield, California, USA

501-1000 employees