Comagine Health is looking for a remote Intake Representative (in Pacific Time Zone). In this role, you will assist providers with the submission of requests for medical and surgical services requiring utilization review. You will review these requests, evaluating the information to ensure the information necessary has been submitted, assisting to obtain complete information as needed. A non-clinical review is completed and then you forward the request on for further review by the clinical team. You'll also convey case information and other notifications via inbound and outbound calls, and system web notifications. If you are very detailed oriented, enjoy investigating information and learning new things every day, we encourage you to read on and apply for this opportunity. Candidates who reside in Pacific Time Zone are preferred.

Who is Comagine Health?

Comagine Health is a non-profit health care consulting firm whose mission seeks to improve health and to increase the effectiveness and quality of health care. As a recognized Quality Improvement Organization (QIO), we support providers, health plans, purchasers, and consumers, and offer services to state and federal agencies and others to help them better manage health care under the existing system and to assess, plan for and implement broader system transformation. We collaborate with academic, government, and nonprofit partners on initiatives funded by NIH, CDC, AHRQ, BJA, SAMHSA, and others. In short, we are changing healthcare at a fundamental level.

Typical Job Duties and Responsibilities:

• Validate the request submitted via the Comagine Health Provider Portal for accuracy and completeness.
• Screen requests for required clinical information based on type of request, determining if information is sufficient for clinical review.
• Obtain clinical information from the client systems when indicated or contact provider to obtain information required for review.
• Process requests after physician review, evaluating language and working with physician reviewers, clinical reviewers, or managers to ensure language and determination information is complete before sending letters to providers.
• Respond to inbound telephone requests with clear documentation in the care management system.
• Enter case information from original source documentation or validate information entered by providers in the portal.
• Provide notification of completed review and additional information needed, when applicable.
• As requested, contribute to orientation and training of other non-clinical employees.
• As requested, create templates for complex reviews, perform internal quality reviews, and/or participate in provider outreach activities.
• May perform scripted non-clinical reviews and refer reviews requiring further action to clinical review staff
• After physician review, notify providers of decertification or potential denial of services by phone or in writing as required by contract.

Competencies:

• Intermediate understanding of medical terminology.
• Intermediate MS Office Suite proficiency.
• Demonstrated proficiency with medical terminology.
• Participates in orientation and training of other Intake staff.

Required Qualifications:

• High school diploma or equivalent (equivalent combination of education and/or work experience in related field may be substituted).
• 2 years of related work experience or customer service experience.
• 1 year of work experience in healthcare.

Candidates who reside in Pacific Time Zone are preferred.

Desired Qualifications:

• 2 years of work experience in healthcare; nursing assistant or medical assistant experience.
• Post-secondary education or certification in a health care related field.

Salary Range: $17.50 - $24.00 per hour

The salary range posted reflects the range that Comagine is willing to pay for this position. Salary is determined by many factors, including but not limited to geographic location of where the employee will perform their job duties in addition to their knowledge, skills, education, and relevant work experience.

We offer competitive pay and benefits. Additionally, employment with Comagine Health qualifies if you apply for the Public Service Loan Forgiveness (PSLF) Program.