Intake Specialist

As an Intake Specialist, you will be a key part of the initial review process for medical and surgical service requests. You'll ensure that provider submissions are complete, accurate, and include all required clinical information. You'll also serve as a point of contact with providers, helping to gather missing data, and forwarding submissions to the clinical review team. Clear and timely communication is essential.

• Review incoming requests submitted via the Provider Portal for medical/surgical services. Validate that submissions are accurate and complete.
• Screen requests to determine whether the clinical information included is sufficient for further review; if not, follow up to obtain missing information from providers or client systems.
• Enter or verify case information in the management system, ensuring data integrity and accuracy.
• After physician or clinical review, process determinations (approvals, decertifications, denials) and prepare communications/letters to providers. Ensure required contract or regulatory notification procedures are followed.
• Respond to inbound phone calls and system notifications from providers or other stakeholders, documenting interactions clearly in the care management system.
• Notify providers of completed reviews and any additional information needed.
• Support orientation and training of other intake / non clinical staff as needed.
• Assist in quality assurance / internal reviews of intake workflows, templates, and provider outreach when required.