Address
Form of workResponsibilities:
The Investigative Intake Specialist is responsible for managing cases from receipt of referral through conclusion of intake process and prepares required documentation for investigative triage
Major Accountabilities:
Education/ Experience:
The Investigative Intake Specialist is responsible for managing cases from receipt of referral through conclusion of intake process and prepares required documentation for investigative triage
Major Accountabilities:
- Maintain portals of tips and referrals into the SIU; receive and maintain documents referred to the SIU; acknowledge and validate referrals to the department; enters referrals into the SIU case management system; researches and documents related information for investigative staff.
- Completes follow-up on referrals received by the SIU through written and oral communications with internal company staff, providers, members, etc.
- Within areas of job responsibilities, identifies systemic issues of fraud waste and/or abuse for the AmeriHealth Caritas Family of Companies.
- Conducts research of various state laws and regulations and plan policies that have an impact on SIU operations. Build and prepare ad-hoc reports of SIU related activity on a weekly/monthly/quarterly basis for management to include, but not limited to, reports/reconciliation of tips and referrals received by the SIU, member service verification reports, and reports to all lines of business.
- Attends and participates in SIU related meetings and required trainings.
Education/ Experience:
- Associate's Degree.
- Bachelor's Degree preferred.
- CPC Certification a plus.
- AHFI/CFE Certification a plus.
- 1 to 3 years Research /Investigative Experience.
- In-depth knowledge of claims processing and medical terminology preferred.
- Healthcare or Managed Care experience preferred
- In-depth knowledge of Microsoft Office and PC applications in a window based environment required.
- Knowledge of MS Access preferred.
- Ability to use MS Excel pivot tables and charts.
- Possesses strong analytical and problem solving skills.
- Displays a high level of initiative and is action oriented.
- Learns new skills, knowledge, and systems quickly.
- Displays the ability to multi-task, prioritize work and manage time.
- Demonstrates effective oral and written communication skills.
