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Clinical Support Coordinator
3 months ago
This is a remote role with occasional (roughly 1x/every other month) onsite team meetings in Somerville, MA.
Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.
Our work centers on creating an exceptional member experience - a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated.
We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.
The Clinical Support Coordinator is responsible for providing administrative support to the Care Managers (CM) and processing authorizations and non-contracted provider referrals, notifications in accordance with established contractual, benefit and clinical policies and guidelines. The primary accountabilities of the position include the research, analysis, adjudication and data entry of service requests and notices received by fax, telephone, mail, email or electronically. The incumbent is also responsible for ensuring that service requests, notices and acknowledgements are processed in a timely, accurate manner in compliance with performance standards regarding telephone service levels and authorization/referral turnaround time and quality. Additionally, the incumbent will assist in various care management and member outreach initiatives and serve a primary role in the research of demographic information, conducting of surveys, generation of reports and other projects and duties as assigned.
Essential Functions
* Provide support to UM Care Managers to ensure provider and member customer satisfaction.
* Respond in a timely and accurate manner to internal and external customer inquiries regarding MGB Health Plan and Clinical administrative policies and procedures.
* Process outpatient and inpatient authorizations/referrals using appropriate criteria for approval.
* Achieve and maintain compliance with telephone accessibility and authorization/referral performance standards.
* Process online and faxed authorization requests using desktop procedures.
* Upload clinical information to appropriate authorization in MGB Health Plan's online provider portal.
* Enter and/or update clinical information as directed by Care Managers.
* Lead and/or collaborate with other MGB Health Plan's departments in efforts to achieve success in member care/case management.
* Provide support for various care management and member outreach initiatives.
* Provide alternate coverage during staff absences and position vacancies, as directed.
* Hold self and others accountable to meet commitments.
* Ensure diversity, equity, and inclusion are integrated as a guiding principle.
* Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
* Build strong relationships and infrastructures that designate MGB Health Plan as a people-first organization.
* Attend meetings as needed.
* Coordinate and assist with team projects as directed.
* Other duties as assigned with or without accommodation.
Working Conditions and Physical Effort
* Work is normally performed in a typical remote office work environment with an occasional onsite component
Knowledge and Education
Required:
* Associate Degree or High School Diploma.
Experience
Required:
* Health care delivery, medical billing, coding and/or customer service experience.
Preferred/Desired:
* Bilingual highly desired
Skills/Competencies
* Demonstrate MGB Health Plan's core brand principles of always listening, challenging conventions, and providing value.
* Strong aptitude for technology-based solutions.
* Ability to inject energy, when and where it's needed.
* Respect the talent and unique contribution of every individual, and treat all people in a fair and equitable manner.
* Exercise self-awareness; monitor impact on others; be receptive to and seek out feedback; use self-discipline to adjust to feedback.
* Be accountable for delivering high-quality work. Act with a clear sense of ownership.
* Bring fresh ideas forward by actively listening to and working with employees and the people we serve.
