RCM Intake Specialist - Behavioral Health: (Remote)

Patient Intake and Referral Management

Manage inbound patient and referral inquiries from patients, families, healthcare providers, care coordinators, discharge planners, payer representatives, and other referral sources.

Conduct standardized intake screening to determine service eligibility, payer requirements, coverage, and appropriate next steps.

Collect and validate patient demographic, insurance, referral, and other information required to support accurate registration and reimbursement.

Coordinate eligible patients through the intake process with the goal of completing registration and scheduling efficiently.

Follow up on incomplete referrals, missing documentation, and outstanding intake requirements.

Communicate clearly with patients and referral sources regarding required documentation, insurance requirements, scheduling, and next steps.

Eligibility and Benefits Verification

Verify insurance eligibility and benefits in real time using payer portals and direct payer communication.

Confirm active coverage, plan type, network status, deductibles, copays, out-of-pocket requirements, visit limitations, and other applicable benefit information.

Identify prior authorization requirements and ensure authorization needs are initiated or appropriately routed before services are provided.

Understand and apply the distinction between insurance eligibility, benefits, prior authorization, and medical necessity requirements.

Accurately document verified insurance and benefit information within applicable EHR, practice management, and revenue cycle systems.

Escalate discrepancies in coverage or payer requirements to appropriate revenue cycle or operational teams.

Scheduling and Patient Access Coordination

Schedule eligible patients for appropriate services following completion of required intake and payer verification activities.

Provide patients with accurate appointment information and instructions regarding required forms or documentation.

Coordinate with operational, clinical, authorization, and billing teams when additional information or action is required before scheduling.

Track scheduled appointments and support follow-up activities related to cancellations, no-shows, or incomplete intake requirements.

Maintain timely communication with referral sources regarding intake status and outstanding requirements.

Revenue Cycle Support

Support clean front-end revenue cycle processes by ensuring demographic, insurance, eligibility, benefit, and authorization information is accurate before services are rendered.

Identify potential reimbursement barriers during intake and escalate them before they result in avoidable denials or delayed payment.

• Coordinate with authorization, billing, and other RCM teams to resolve payer-related issues.
• Maintain knowledge of payer requirements and workflow changes affecting patient access and reimbursement.
• Support process improvements designed to increase intake completion, scheduling conversion, documentation accuracy, and clean claim performance.

Documentation and Compliance

• Maintain complete and accurate intake documentation within applicable healthcare systems.
• Document referral source, payer information, eligibility and benefit verification, authorization status, appointment information, and required follow-up.
• Maintain patient confidentiality and comply with HIPAA and applicable healthcare privacy requirements.
• Support accurate records for payer audits, internal quality reviews, and revenue cycle reporting.
• Follow established documentation standards and quality requirements.

Performance and Quality

• Meet established performance expectations related to intake completion, conversion, documentation accuracy, call quality, and first-contact resolution.
• Maintain accuracy while working in a high-volume environment.
• Participate in quality reviews, coaching, training, and workflow improvement initiatives.
• Identify recurring intake or payer issues and communicate opportunities for process improvement.

Qualifications

Minimum of two years of experience in healthcare intake, patient access, admissions, insurance verification, or another front-end Revenue Cycle Management function.

• Prior intake, patient access, or RCM experience supporting behavioral health services is required.
• Experience verifying insurance eligibility and benefits using payer portals such as Availity, NaviNet, or similar systems.
• Working knowledge of insurance eligibility, benefits, prior authorization, and payer requirements.
• Experience working with commercial and managed care insurance plans.
• Experience using EHR, practice management, or other healthcare revenue cycle systems.
• MediCal experience preferred.
• Ability to manage multiple systems and workflows simultaneously while communicating with patients or referral sources.
• Strong verbal and written communication skills.
• Strong attention to detail and ability to maintain accurate patient and payer information.
• Working knowledge of HIPAA and healthcare confidentiality requirements.

Ability to communicate professionally with patients, families, healthcare providers, payer representatives, and internal teams.

Requirements

Associate degree or higher in healthcare administration, business, psychology, social work, public health, or a related field.

Experience in patient access, admissions coordination, healthcare call center, or centralized intake operations.

• Experience working across multiple payer types and healthcare service lines.
• Experience identifying and coordinating prior authorization requirements during the intake process.
• Experience working in a performance-driven intake or patient access environment.
• Bilingual English/Spanish communication skills preferred.
• Candidate will need to be able to support a work schedule in the Pacific time zone.
• US based candidates eligible for employment without sponsorship.