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Clinical Support Specialist II
2 months ago
We are seeking a highly skilled and detail-oriented Clinical Support Specialist to join our team at Capital Blue Cross. As a key member of our Medical Management department, you will play a critical role in supporting the delivery of high-quality healthcare services to our members.
Key Responsibilities- Provide administrative support to the Medical Management department, including the Preauthorization, Medical Claims Review, Concurrent Review, and appeals units.
- Conduct intake services, including coordination between units within the Clinical Management Department.
- Process referrals/requests/records received for services and forward to the appropriate team member after researching and/or verifying member eligibility and benefit information.
- Provide telephone support to the unit for assigned queue.
- Provide eligibility and claims status support, both internally and externally, for non-clinical issues relating to specific cases.
- Perform administrative duties to support the core functions of the unit, as requested, such as taking meeting minutes, monitoring office equipment, mailing and distributing various letters created by staff, scheduling meetings, purging files, and faxing.
- Act as the Records Point of Contact for assigned Unit.
- Promote personal growth through participation in staff meetings, appropriate in-services, and corporate training.
- Comply with established departmental policies and desktop procedures.
- Conduct self in a professional manner with staff in other departments within Capital Blue Cross as well as the provider community.
- Work as a respectful member of the team in a collaborative manner to complete duties and to solve problems.
- Demonstrate the ability to be detail-oriented and accurate with assigned work.
- Identify opportunities for improvement of overall functioning of the unit to develop more efficient processes and to move the business forward.
- Assist in the orientation of new employees.
- Provide special project assistance as needed.
- Complete any special assignments/reports in a complete and timely manner.
- Participate in the development of desktop procedures related to position.
- Possesses a high school diploma or G.E.D. with 2 to 3 years' experience in the medical health field (e.g., medical assistant, medical secretary) or 2 to 3 years' experience in a managed care clinical department.
- Working knowledge of medical terminology.
- Able to demonstrate competence with and/or ability to learn various health plan computer systems (e.g., FACETS, Impact Pro, FEP, CAIC, CCA, and Image).
- Working knowledge of the insurance industry, health plan benefits, and product lines (e.g., PPO, POS, HMO, FEP, Senior Products, Traditional/Comprehensive).
- Knowledge of regulatory and accreditation standards and requirements preferred (e.g., NCQA, URAC, Pennsylvania Department of Health and Department of Insurance, ERISA, Act 68).
- Preferred experience in a managed care organization with specific experience related to clinical management.
- Excellent customer service skills in order to work with internal and external customers, and ability to communicate effectively both verbally and in writing.
- Strong organizational skills with the ability to be flexible and prioritize workload based on departmental needs.
- Must have quality standards and capability to produce and record information with attention to detail, accuracy, and within time standards established by the Sr. Team Lead/Manager.
- Able to perform basic mathematical calculations (e.g., addition, subtraction, multiplication, and division).
- Experienced utilizing a PC and various software packages (e.g., Microsoft Office Suite) with keyboarding skills equivalent to 40 words per minute.
We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital Blue Cross, you will work alongside a diverse and caring team of supportive colleagues, and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career.
And by doing your best, you'll help us live our mission of improving the health and well-being of our members and the communities in which they live.
