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Intake and Health Insurance Benefits Specialist

Department: Community Health & Research Center
Location: Dearborn, MI

Job Title:† Intake and Health Insurance Benefits Specialist

Employment Type:† † †Full-Time

Job Summary: †Under very general supervision, provides intake, health benefit eligibility screening and information services to ACCESS clients. Responsible for screening all Mental Health clients to determine health benefits, public benefits eligibility and insurance verifications. The Intake and Health Insurance Specialist will seek to maximize benefits available in private and public programs. Quality patient care and patient satisfaction is the primary goal.

Essential Duties and Responsibilities:

  • Answer calls and questions inquiring about services
  • Screens individuals on the phone in order to match to the appropriate department and guide them through the enrollment process into that department.
  • Provides a warm transfer to Wellplace to make sure client makes the initial contact.
  • Oversee Mental Health Ė Wellness Information Network (MH-WIN) Calendar and schedule Intake appointments to the appropriate department.
  • Verifies client insurance coverage and prepares Evolv case with all demographic and benefits information.
  • Conducts intake interviews with new or re-admitted clients to gather necessary administrative information; computes and verifies family income and size and places client appropriately on sliding scale if requested, and explains billing policies and fees to client.
  • Issues notices and revised fee agreements, compiles data, and enters information for sliding scale reduction updates.
  • Analyzes intake reports and initiates corrective action as necessary to insure accuracy and completeness of administrative information.
  • Maintains current knowledge regarding third-party and first-party payment procedures and regulations as well as preferred provider agreements.
  • Refers clients with possible Medicaid eligibility criteria and/or unresolved account questions.
  • Tracks enrollment status of clients assisted and provides support as appropriate to complete enrollment and/or document barriers to enrollment, if any.
  • Provides excellent internal/external customer services via telephone, email or face-to-face contact to assist patients and clients with their eligibility and enrollment needs, and staff with questions or concerns regarding health coverage programs processes and requirements.
  • Enrolls and informs patients, clients about insurance affordability through the local health exchanges and public insurance programs to encourage participation.
  • Keeps current with trends and developments related to essential job competencies
  • Protects confidentiality of patients and clients at all times.
  • Follows policies and procedures for timely and complete documentation in the Electronic Medical Record (EMR)
  • Attends regular team meetings
  • Attends monthly staff meetings and all mandatory organization activities
  • Takes fax orders from referring sources for new patient; schedules new evaluations, schedule/reschedule patients via phone calls and/or therapistsí direction as required.
  • Projects positive, flexible attitude in attempting to meet patientís scheduling needs.
  • Keeps accurate, up-to-date files of all referrals received in the department. Pre-registers for all disciplines before first appointment preparing chart within EMR.
  • Copies and mails/faxes initial evaluations and progress/discharge notes, when signed by therapist, or physicians to appropriate physicians.
  • Performs reception functions and assures that the telephones are answered, and patients/visitors are greeted in a timely, courteous and professional manner.
  • Performs registration functions and assures timely, efficient and customer-friendly registration system.
  • Processes insurance eligibility and benefits verification for all patients.
  • Processes insurance pre-authorizations for all patients.
  • Assists in resolving account denials.
  • Keeps prior authorization Work Queue list up-to-date and follows-up on aging requests.
  • Works with department staff to resolve pre-billing edits to ensure timely filing and clean-claim requirements.
  • Performs other duties assigned.

Knowledge, Skills, and Abilities:


Knowledge of:

  • Uninsured and underserved populations.
  • Commercial and workerís compensation insurance

Skill in:

  • Critical thinking with the ability to effectively problem solve (e.g. able to determine if a patient issue requires immediate provider attention if there are significant changes to the patient history or other clinical issues that are presented).
  • Strong customer service skills.
  • Strong multi-tasking skills.
  • Organizational and time management skills to effectively juggle multiple priorities, time constraints and large volumes of work.

Ability to:

  • Operate a standard desktop and Windows-based computer system, including but not limited to, electronic medical records, Microsoft Word, Excel, Outlook, intranet and computer navigation.
  • Master the rules of a number of complex public benefits programs.
  • Ability to establish positive relationships with associates, volunteers, third party intermediaries.
  • Be highly organized with the ability to multi-task and adapt to changing priorities.
  • Establish and meet deadlines.
  • To be able to evaluate each registration/admission and be alerted to potential problems, including pre-certification or financial assistance for the patient.
  • Use other software as required while performing the essential functions of the job.
  • Communicate effectively with both written and verbal forms, including proper phone etiquette.
  • Work collaboratively in a team-oriented environment; courteous and friendly demeanor.
  • Work effectively with various levels of organizational members and diverse populations including ACCESS staff, patients, family members, insurance carriers, outside customers, vendors and couriers.
  • Cross-train in other areas of practice in order to achieve smooth flow of all operations.
  • Exercise sound judgment and problem-solving skills, specifically as it relates to resolving billing and coding problems.
  • Handle patient and organizational information in a confidential manner.
  • Work under minimal supervision.

Educational/Previous Experience Requirements:

Minimum Degree Required:

    • Associateís Degree
    • Bachelorís Degree Preferred
  • 3-5 years previous healthcare experience including experience with medical insurance processing, Medicare, Medicaid, CCI edits, Medicare Functional Therapy Reporting and Therapy Cap requirements, local payer coding and billing guidelines as they pertain to physical, occupational, or speech therapy preferred or equivalent combination of education, experience, and/or training approved by Human Resources.

Licenses/Certifications:

  • Licenses/Certifications Required at Date of Hire:
    • none

Working Conditions:

Hours:†† Normal business hours.† Some additional hours may be required.

Travel Required: local travel

Working Environment:††† Climate controlled office environment during normal business hours.

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