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Clinical Administrative Coordinator

2 months ago

Arcadia, California, United States Allmed Staffing Inc Full time
Job Description

A leading healthcare staffing agency, Allmed Staffing Inc, is seeking a highly skilled Clinical Administrative Coordinator to join their team.

Job Summary:

The Clinical Administrative Coordinator will provide non-clinical support to the utilization management team in maintaining and managing the utilization processes for pre-service authorization requests in a timely and accurate manner consistent with policies and procedures as described in the Utilization Management plan.

Key Responsibilities:

  • Consistently exhibits behavior and communication skills that demonstrate commitment to superior customer service, including quality, care and concern with each and every internal and external customer.
  • Performs all functions of the care coordinator.
  • Provides non-clinical support to the CDU nurse in the processing of all adverse determinations and notices including provider outreach for denial avoidance, accessibility verification and benefit validation.
  • Ensures informational notices for carve outs and benefits are composed in a manner consistent with federal regulations, state regulations, health plan requirements and NCQA standards.
  • Converts service description and diagnosis into language that is easily understood based on resources provided and clinical direction.
  • Validates the accuracy of all information provided in the carve out and benefit notices including carve out providers and contact information provided relevant to aforementioned notices.
  • Contacts members or providers for continuity of care services related to carve out notices.
  • Adheres to the standardized documentation requirements for carve out and benefit notices.
  • Documents members' service benefits by contacting the appropriate health plans.
  • Directs providers and members to contracted provider network and facilities.
  • Processes appropriate authorizations for HMO / PPO clients as specified in the organization's procedures.
  • Acts as a resource to other coordinators, staff and providers by resolving issues and responding to requests in a timely and effective manner.
  • Works with patient services regarding member concerns.
  • Identifies gaps in training or process impacting the overall compliance of adverse determinations and communicates in writing an effective performance improvement solution.

Requirements:

  • High school diploma, G.E.D. or equivalent.
  • Certificate in a healthcare related field preferred.
  • Minimum 1 year of experience performing non-clinical functions for prospective UM review.
  • Preferred 1 year of experience providing supportive or direct functions for adverse determinations.
  • 3 to 5 years of experience in a health care setting.
  • 2 years referrals management or related experience.

Preferred Qualifications:

  • Computer literate.
  • Proficient in Microsoft Office Suite, knowledge of utilization management platforms and the capacity to navigate varied health plan websites for benefit determinations.
  • Ability to type 30 wpm.
  • Broad knowledge of managed care principles.
  • Knowledge of medical terminology and CPT/ICD-9 coding.
  • Excellent communication, organization and customer service skills.
  • Proven ability to problem-solve.
  • Strong attention to detail.
  • Ability to manage time effectively and work independently.