[Hiring] Intake Representative @COMAGINE HEALTH

Role Description

Are you passionate about detail-oriented work that keeps processes running smoothly and accurately? Do you enjoy piecing together information, working across multiple systems, and playing a key role in supporting high-quality outcomes?

In this remote Intake Representative role, you will work in a fully electronic environment, reviewing incoming requests for utilization review and other medical management services, verifying that documentation is complete and accurate, and ensuring cases are ready for clinical review. Your work involves:

• Using an electronic medical record system and other platforms to validate eligibility.
• Confirming claim and provider information.
• Comparing documentation across sources.
• Following up as needed to gather missing details.
• Balancing queue-based work with inbound calls.
• Managing priorities independently throughout the day.

We’re looking for someone with a strong healthcare support background, including:

• Comfort with medical terminology.
• Documentation review.
• Validating detailed information for accuracy and completeness.

If you are naturally curious, able to work independently, and bring a high level of attention to detail and consistency in your work, we encourage you to apply.

You must reside in the Mountain Time Zone and be available to work Monday through Friday, 8:00 AM to 5:00 PM, MST.

Qualifications

• High school diploma or equivalent or 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.
• Post-secondary education or certification in a related field preferred.
• 2 years of work experience in healthcare; nursing assistant or medical assistant experience.

Requirements

• Intermediate understanding of medical terminology.
• Intermediate Microsoft Office Suite proficiency.
• Demonstrated proficiency with medical terminology.

Responsibilities

• Validate the request submitted via the Comagine Health Provider Portal for accuracy and completeness.
• Screen cases for required medical 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.
• Determine based on training when a scripted review is indicated based on contract requirements.
• Process requests after 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 of calls.
• Enter case information from original source documentation or validate information entered by providers in the portal.
• Make courtesy calls with case reference numbers.
• Provide notification of completed review and additional information needed, when applicable.
• Contribute to orientation and training of other non-clinical employees.
• Create templates for complex reviews, perform internal quality reviews, and/or participate in provider outreach activities as requested.
• May perform scripted 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.
• Complete case after review, returning to clinician or sending to client based on procedure.
• Arrange ancillary authorization requests such as transportation and accommodation.
• Obtain customer consent for care management services to be performed.
• Correspond with facilities, providers, and others.
• Coordinate non-clinical functions and intervention, as directed.
• Perform supervised closure of cases upon completion of review by a clinical reviewer, as directed.

Benefits

• Medical, dental and vision insurance.
• Paid time off for vacation, illness and volunteering.
• Retirement savings plan with employer contribution.
• Adoption financial assistance.
• Paid parental leave.
• And much more!

Company Description

Comagine Health is a national, mission-driven, nonprofit organization that has engaged in health care quality consulting and quality improvement services for more than 50 years. We are leaders in assisting front-line providers and engaging health care partners to improve care delivery and patient outcomes. Our talented remote workforce spans the country and plays a vital role in our success. We go beyond merely providing a remote work option; we support and embrace it. We offer opportunities to make a difference from anywhere in the U.S. and enjoy better work-life balance. An annual stipend gives you the freedom to enhance your workspace with options that suit your needs.

We believe in an environment that allows you to thrive both personally and professionally.