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Clinical Support Associate
5 months ago
Job DetailsJob LocationMain Office - Santa Barbara, CAPosition TypeFull TimeTravel PercentageNoneJob CategoryMedical ManagementDescriptionSalary Range: $22.56 - $31.58 per hourJob SummaryA 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 & ResponsibilitiesTimely answering of inbound calls in the Health Services' phone queuesMake outbound calls to providers, members, and CenCal Health staff regarding operational processesTimely communication of conflicts or difficulties with members or providers to the immediate supervisorMaintain confidentiality and privacy of member information in adherence to HIPAA and Confidentiality laws and regulationsAdhere to CenCal Health's mission, protocols, policies and procedures and meet required performance standardsTimely attendance of Company-wide and department meetings and trainings and, as appropriate, actively participateRespond to emails, telephone calls, and other modes of communication promptly, professionally and courteouslyInteract with CenCal Health employees, members, and providers professionallyResponsible for supporting the daily operational functions, facilitating timely work processes, and performing clerical activities associated with ECM/CSWork closely with CM, ECM/CS team and internal CenCal Departments related to ECM/CS activitiesManaging 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 contactsAssist with mailings associated with ECM/CS (Member assignment and Auth approval notifications)Accurately enter authorization requests and submitted documents into the authorization systemAct as a liaison between clinical reviewers and providers/membersAccurately enter billing and diagnosis codes, category and type of service, amount, frequency, and/or volume of requested or approved services and proceduresProcess authorization requests within established timeliness standardsAccurately prepare, edit and finalize written determination notices to providers and membersAssist with mailings of ECM/CS NOA's as requested Assist the ECM/CS Program Manager with data tracking as requested Other duties as assignedQualificationsKnowledge/Skills/AbilitiesRequired:Ability to work independently and follow directions with minimal supervision and as an active participant of an interdisciplinary teamAbility to utilize constructive feedback as a learning and growth opportunityDemonstrate excellent organizational and multi-tasking skillsUnderstand basic medical terminology, billing (CPT) and diagnoses (ICD-10) codingMaintain member confidentiality and HIPAA complianceMust 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 wpmWork effectively with people with varying backgrounds and educational levelsPrepare grammatically correct, clear and concise correspondence Preferred:Basic knowledge of Medi-Cal and its covered servicesKnowledge 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 & ExperienceRequired:High school diploma or GEDTwelve (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 experiencePreferred: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
