Clinical Support Associate

2 weeks ago

Santa Barbara, United States Cencal Health Full time

Job Summary A Clinical Support Associate Enhanced Care Management (CSA-ECM) is assigned to Enhanced Care Management Unit of Medical Management. The CSA-ECM reports to the ECM Program Manager. The CSA-ECM is responsible for providing coordination support for the clinical teams, supporting the daily operational functions, facilitating timely work processes, and performing clerical activities of the ECM unit. The CSA-ECM must have strong and clear written and verbal communication skills. The CSA-ECM is responsible for accurate and timely data entry and data collection. The CSA-ECM interacts with other CenCal Health employees, providers, and members. The CSA-ECM is responsible for processing authorization and referral requests. Duties & Responsibilities * Timely answering of inbound calls in the Health Services' phone queues * Make outbound calls to providers, members, and CenCal Health staff regarding operational processes * Timely communication of conflicts or difficulties with members or providers to the immediate supervisor * Maintain confidentiality and privacy of member information in adherence to HIPAA and Confidentiality laws and regulations * Adhere to CenCal Health's mission, protocols, policies and procedures and meet required performance standards * Timely attendance of Company-wide and department meetings and trainings and, as appropriate, actively participate * Respond to emails, telephone calls, and other modes of communication promptly, professionally and courteously * Interact with CenCal Health employees, members, and providers professionally * Responsible for supporting the daily operational functions, facilitating timely work processes, and performing clerical activities associated with ECM/CS * Work closely with CM, ECM/CS team and internal CenCal Departments related to ECM/CS activities * Managing the call queue; to include providing support to members, ECM/CS providers and internal departments, related to ECM/CS referrals and provider reassignment process. * Responsible for the ECM/CS referral intake process and ECM provider assignment. * Conduct follow up calls to members and providers to ensure timely access to ECM/CS services * Organize, schedule, track and monitor member contacts * Assist with mailings associated with ECM/CS (Member assignment and Auth approval notifications) * Accurately enter authorization requests and submitted documents into the authorization system * Act as a liaison between clinical reviewers and providers/members * Accurately enter billing and diagnosis codes, category and type of service, amount, frequency, and/or volume of requested or approved services and procedures * Process authorization requests within established timeliness standards * Accurately prepare, edit and finalize written determination notices to providers and members * Assist with mailings of ECM/CS NOA's as requested * Assist the ECM/CS Program Manager with data tracking as requested * Other duties as assigned Qualifications Knowledge/Skills/Abilities Required: * Ability to work independently and follow directions with minimal supervision and as an active participant of an interdisciplinary team * Ability to utilize constructive feedback as a learning and growth opportunity * Demonstrate excellent organizational and multi-tasking skills * Understand basic medical terminology, billing (CPT) and diagnoses (ICD-10) coding * Maintain member confidentiality and HIPAA compliance * Must be detail-oriented and maintain clear and accurate records * Complete assigned duties while adhering to regulatory timelines * Must be able to type at a minimum of 35 wpm * Work effectively with people with varying backgrounds and educational levels * Prepare grammatically correct, clear and concise correspondence Preferred: * Basic knowledge of Medi-Cal and its covered services * Knowledge of health-related community-based organizations, health care delivery systems, and resources for the low income and elderly population * As designated, bilingual in Spanish (not required for Utilization Management positions) Education & Experience Required: * High school diploma or GED * Twelve (12) months of full-time, or its equivalent, experience in a medical office, health plan, managed care organization, hospital (ED or inpatient), skilled nursing facility, clinic or other healthcare setting working directly with patients, members, providers and/or other clinicians. * Successful completion of one of the following accredited education programs: Medical Assistant or Medical Office Professional. Successful completion can substitute for six (6) months of work experience Preferred: * Associate degree in business, health science, healthcare, health management or related field OR three (3) years of experience as a Certified Medical Assistant, Certified Nursing Assistant or Licensed Vocational/Practical Nurse may substitute for an associate degree * Bachelor's degree in one of the above fields * Two (2) years of full-time, or its equivalent, of clinical experience in an outpatient or ED clinic, health plan, managed care or medical office setting

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