Intake Specialist - St. Claire Regional Medical Center

Position Summary:
The Intake Specialist actively facilitates a successful patient intake process for IRU patient stays. This position demonstrates knowledge about inpatient rehab and SNF care standard concepts, practices, and procedures and incorporates regulatory updates and guidelines into practice.

Duties/Responsibilities:
• Receives new referrals from internal and external referral sources.
• Maintains good report with existing and potential referral sources.
• Evaluates the referral clinical documentation for medical necessity and appropriateness of IRU level of care according to applicable rules and regulations.
• Works with the case manager of referral source to get additional clinical documentation.
• Communicates timely with referral source and rehab team regarding admission process and timeframes.
• Establishes and maintains payor contact and referral information for timely escalation of issues.
• Verifies coverage of primary insurance payor.
• Contacts insurance payors and submits pre-authorization for TCU/IRU admission with Medicaid, Advantage plans, and other insurance payors.
• Screens for medical appropriateness.
• Complies with rules/regulations/COPs, insurance management process.
• Communicates complete and accurate information to 3rd party payors, internal and external customers/referral sources.
• Serves as a liaison among 3rd party payors, patient/family and staff to ensure necessary services are provided promptly and effectively.
• Assists with arranging peer-to-peer reviews as necessary.
• Manages timely submission of payor requirements for admission, continuation of stay, updates, and discharge.
• Communicates with clinical team when insurance updates are due in order to get appropriate documentation for submission purposes.
• Identifies, escalates and works to resolve system problems, barriers and delays that impede the admission, plan of care, discharge or reimbursement and initiates recommendations/options rather than wait for a problem to arise.
• Completes the necessary Pre-Admission Screening (PAS) timely and accurately to be in compliance with Conditions of Participation and regulations.
• Maintains timely and accurate record of insurance authorizations details in Meditech to ensure prompt payment of claims.
• Collaborates and communicates with Patient Access Department and Business Office on individual cases and to ensure effective revenue cycle.
• Models effective team behaviors such as constructive discussion of differences, supporting team decisions, and placing team successes above individual preferences and routines.
• Establishes a rapport with people easily and develops and maintains a network of contacts who can provide information, help and access to others.
• Demonstrates a willingness to assume additional responsibilities.
• Demonstrates an understanding of the link between own job responsibilities and the overall goals and needs of SCH.
• Performs own job with the broader goals in mind.

Education:
Associate Degree in Nursing (ADN) or higher. Bachelor Degree in Nursing (BSN) preferred.

Experience:
Utilization or case management experience preferred.

Licensure/Certification:
Must hold a current license from the Kentucky Board of Nursing.

Physical/Work Requirements:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit and use hands to finger, handle or feel. The employee is required to communicate effectively. Specific vision abilities required by this job include close vision for reading and computer work. The employee must regularly lift and/or move up to 10 pounds, frequently lift and/or move up to 25 pounds, and occasionally lift and/or move more than 50 pounds.
The work environment described here is representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee works in an area with good lighting and climate control. The noise level in the work environment is usually moderate.

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