Clinical Support Associate
2 weeks ago
Job Details
Job Location
SLO Office - San Luis Obispo, CA
Position Type
Full Time
Travel Percentage
None
Job Category
Medical Management
Description
Salary Range: $22.56 - $31.58 per hour
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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