Description

We are in search of an Intake Specialist to join our team. This role is situated within the healthcare industry, specifically dealing with Medicare Advantage Member appeals from providers. The workplace is based in Durham, North Carolina, and offers a short-term contract employment opportunity. As an Intake Specialist, you will be tasked with handling a variety of responsibilities, from analyzing and resolving appeals to ensuring compliance with regulatory standards.

Responsibilities:

• Analyze and resolve confidential and sensitive appeals, grievances, and coverage/organization determinations from various stakeholders

• Interpret and explain health plan benefits, policies, procedures, medical terminology, and coding to members or providers

• Exercise judgment independently to make decisions based on policies and guidelines of BlueCross NC

• Prepare files and develop position statements for external reviews, ensuring alignment with independent review organizations, benefit panels, and external medical consultants

• Deliver comprehensive responses to appeals and grievances that align with the decision and comply with regulatory and accreditation guidelines

• Document investigation findings and actions in all applicable systems

• Monitor daily reports to ensure service timeliness and compliance is maintained

• Gather clinical information using established criteria provided in corporate medical policies and collaborate with Medical Directors for decisions regarding clinical appeals/grievances

• Ensure quality, efficiency, and timeliness in all work to comply with applicable State NCDOI, Federal Centers for Medicare & Medicaid Services (CMS), and BCBSNC policies and procedures.

Requirements • Demonstrable experience in Training, Procedures, and Policy

• Strong understanding of Compliance and Research methodologies

• Proven track record in Quality Review

• Knowledge of Medical Coverage and Benefit Functions

• Superior Leadership Skills

• Familiarity with Hiring Processes

• Proficiency in Typing and handling of Financial Notes

• Experience in Clinical Trial Operations

• Ability to use Monitoring Tools effectively

• Coding skills, with a focus on Quality Assurance

• Familiarity with HealthCare.gov and Medicare policies

• Proven experience in handling Appeals and understanding Health Insurance policies

• Knowledge of Medical Terminology is a must

• A Plus certification would be advantageous

• Proficiency in using Fax machines and other office equipment

• Language Interpretation skills would be a significant advantage.

Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.

Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more.

All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.

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